Fetor Hepaticus 'Breath of the Dead'

Fetor hepaticus, commonly referred to as "breath of the dead," is a disorder where a patient's breath has a sweet-musky, and occasionally faecal, aroma. It is connected to portosystemic shunts and portal hypertension.

Fetor Hepaticus:

Fetor hepaticus, one of the clinical symptoms of hepatic encephalopathy, is a late indicator of liver failure in which portal hypertension with portosystemic shunting allows thiols to enter directly into the lungs generating a sweet, musty, or even faintly faecal scent of the breath. Ammonia and ketones in the breath are two other potential causes. More than 5.5 million Americans and hundreds of millions of individuals worldwide are affected by chronic liver disease and cirrhosis.

Dimethyl sulphide and ketones (acetone), to a lesser extent, have been linked to fetor hepaticus, suggesting that there may be an objective, noninvasive way to detect liver failure. In addition, some researchers believe that the volatile dimethyl sulphide is the primary source of fetor hepaticus' offensive odour. Trimethylamine has been proposed to be a contributing factor to the smell of fetor hepaticus and is also associated with liver failure in a secondary form of trimethylaminuria. Trimethylamine in excess may be a factor in the general body odour issues that patients with severe hepatic disease have, leading to a secondary case of the "fish-odor syndrome" in these people.

Fetor Hepaticus Causes:

Fetor hepaticus, a late symptom of liver failure and one of the clinical signs of hepatic encephalopathy, is caused by thiols passing directly into your lungs through portal hypertension and portosystemic shunting, giving off a sweet, musty, or even faintly faecal fragrance to your breath. Ammonia and ketones in the breath are two other potential causes.

Fetor hepaticus is a serious liver condition that results in scarring and impaired liver function. Portal hypertension, or elevated blood pressure in your liver's veins, may occur from this. Blood becomes backed up in the veins surrounding your liver as a result of portal hypertension, which makes it difficult for blood to pass through your liver.

Fetor Hepaticus Symptoms:

Breath that smells like a mixture of rotten eggs and garlic, or perhaps faintly faecal, is the primary sign of fetor hepaticus.

Signs and symptoms of liver failure may include:

•          Yellowing of your skin and eyeballs (jaundice)
•          Pain in your upper right abdomen
•          Abdominal swelling
•          Nausea
•          Vomiting
•          A general sense of feeling unwell (malaise)
•          Disorientation or confusion
•          Sleepiness

Portal hypertension:

A condition known as portal hypertension is one in which the pressure inside the portal vein rises. The splenic vein and superior mesenteric vein combine to produce this big vein. The portal vein transports blood into the liver from the pancreas, spleen, and intestinal mucosa. This blood is full of absorbed fats and other compounds created after meal digestion.

Blood received from the portal vein and hepatic arteries travels through blood channels inside the liver called sinusoids, which are bordered by reticuloendothelial cells. The inferior vena cava serves as the final destination for this blood before it returns to the right atrium of the heart.

Cirrhosis, which is most usually brought on by alcohol consumption, schistosomiasis in developing nations, where the infestation is rampant, and anomalies of the hepatic vein are common causes of portal hypertension.

Anastomoses between the portal system and the systemic veins become dilated and tortuous as a result of portal hypertension. The development of dilated abdominal wall collaterals, radiating veins surrounding the umbilicus (the "caput medusae"), esophageal varices, and dilated submucosal stomach and rectal plexus veins is caused by these anastomoses, also known as portosystemic shunts.

Results of portal hypertension:

Certain volatile sulphur compounds (mostly thiols) and some ketones flow directly through the liver and into the systemic circulation as a result of portosystemic shunting. This indicates that these compounds do not first go through hepatic metabolism before reaching the lungs. These volatile molecules are consequently released in the breath.

Fetor Hepaticus Treatment:

Hepatic Encephalopathy Treatment

Hepatic encephalopathy, often referred to as portosystemic encephalopathy, is a syndrome that affects brain function but is typically reversible and occurs in people who have acute or chronic liver failure or when the liver is bypassed by portosystemic shunts. This causes a range of neurological abnormalities, from mild brain malfunction to coma. It is still entirely unknown what is generating this brain malfunction. 6. Based on the underlying liver condition, hepatic encephalopathy is divided into three types:

Type A: Hepatic encephalopathy associated with acute liver failure.

Type B: Hepatic encephalopathy associated with porto-systemic shunts and no intrinsic hepatocellular disease.

Type C: Hepatic encephalopathy associated with cirrhosis and portal hypertension or porto-systemic shunts.