Fetor hepaticus

• • • • • • • • • • • • • • • Fetor hepaticus or Halitosis is a foul or disagreeable odor that emanates from the mouth. It is also termed bad breath, oral malodor, foul breath, or fetor ex oris. Howe described Halitosis in 1874 until it did not become a clinical entity[2]. Halitosis can be classified into genuine Halitosis, pseudo-halitosis, or halitophobia. Genuine Halitosis can be physiological or pathological based on its origin[3]. Based on the etiology, it is classified as Halitosis due to local factors and systemic factors of pathological and non-pathological origin, Halitosis due to drug administration, and xerostomia[4]. Over 600 species of microorganisms have been identified to have an association with Halitosis. Some of them are Treponema denticola, Porphyromonas gingivalis, Porphyromonas endodontalis, Prevotella intermedia, Bacteroides loescheii, Enterobacteriaceae, Tannerella forsythia, Centipeda periodontii, Eikenella corrodens, Fusobacterium nucleatum, Micromonas micros, Campylobacter rectus, and Eubacterium species[5]. They act on sulfur-containing amino acids like methionine, cysteine, and methyl cysteine to produce volatile sulfur compounds (VSCs) like hydrogen sulfide, methyl mercaptan, and dimethyl sulfide [1] [6]. Halitosis is considered a significant social problem that affects an individual’s self-esteem. Bad breath is usually more of a nuisance rather than a serious medical condition. Most individuals with bad breath can treat and eliminate the disea...

Cirrhosis is the 12th leading cause of death in the United States. Newer research has established that liver fibrosis is a dynamic process and that early cirrhosis may be reversible. Only one in three people with cirrhosis knows they have it. Most patients with cirrhosis remain asymptomatic until the onset of decompensation. When clinical signs, symptoms, or abnormal liver function tests are discovered, further evaluation should be pursued promptly. The most common causes of cirrhosis are viral hepatitis, alcoholic liver disease, and nonalcoholic steatohepatitis. Initial workup includes viral hepatitis serologies, ferritin, transferrin saturation, and abdominal ultrasonography as well as complete blood count, liver function tests, and prothrombin time/international normalized ratio, if not already ordered. Additional testing is based on demographics and risk factors. Common serum and ultrasound-based screening tests to assess fibrosis include the aspartate transaminase to platelet ratio index score, Fibrosis 4 score, FibroTest/FibroSure, nonalcoholic fatty liver fibrosis score, standard ultrasonography, and transient elastography. Generally, noninvasive tests are most useful in identifying patients with no to minimal fibrosis or advanced fibrosis. Chronic liver disease management includes directed counseling, laboratory testing, and ultrasound monitoring. Treatment goals are preventing cirrhosis, decompensation, and death. Varices are monitored with endoscopy and often req...

Fetor hepaticus is a word used for specific breath odor. This breath odor is produced as a result of hepatic malfunctioning or damage known as encephalopathy. The toxins of brain when accumulated in the blood stream cause hepatic encephalopathy. Fetor hepaticus is also known as breath of the dead. Due to the liver late stage disease, the patient experience a foul breath. The toxins in the blood stream should be excreted from it by the use of various medications and dietary modifications. If the condition is not diagnosed and treated on time, it can be prove fatal for patient. Fetor hepaticus Smell Fetor hepaticus is a specified odor which is also known as breath of the dead. This smell is due to the toxins in the blood. These toxins which are not purified by the defected liver, start accumulating in the blood and causing problems in the vital functions of body along with effecting the organs. A foul smell is the result of these accumulated toxins. As these toxins start eliminating from blood, the fetor hepaticus odor also start diminishing. And it is considered a vital sign of treatment goes right and effective. So it is concluded that the odor is all about toxins. Fetor hepaticus Causes The main cause behind fetor hepaticus is the malnutrition or damaged liver, most of the time late stage liver disease is responsible for fetor hepaticus odor. The toxins are purified by the liver from all over the body, but when liver become damage i.e. encephalopathy occurs the liver is n...

By Dr. Liji Thomas, MD Reviewed by Fetor hepaticus, also known as ‘breath of the dead’, is a condition in which the breath of the patient is sweetish, musty, and occasionally fecal in nature. It is associated with portal hypertension with portosystemic shunts. Image Credit: Andrew Angelov / Portal hypertension Portal hypertension is a condition in which there is an increase in the pressure present within the portal vein. This vein is large and formed by the union of the superior mesenteric vein with the splenic vein. The portal vein drains blood from the intestinal mucosa, spleen, and pancreas, into the liver. This blood is rich in absorbed lipids and other molecules formed by the digestion of food. Inside the liver are sinusoids, which are blood channels lined by reticuloendothelial cells that contain blood received from the portal vein and the hepatic arteries. This blood drains into the hepatic veins and finally into the inferior vena cava before returning to the right atrium of the heart. Common causes of portal hypertension include cirrhosis, which is most frequently due to alcohol abuse, schistosomiasis in developing countries, where the infestation is rife, as well as abnormalities of the hepatic vein. As a consequence of portal hypertension, anastomoses between the portal system and the systemic veins become dilated and tortuous. These anastomoses, which are referred to as portosystemic shunts, are responsible for the development of dilated abdominal wall collatera...

Fetor hepaticus is a chronic odor in your breath. It’s different from normal ‌ The scent of Learn more about fetor hepaticus and how to manage the condition. Symptoms of Fetor Hepaticus Fetor hepaticus is a distinctive breath odor that people with ‌ But it is not related to hygiene or ‌ These distinctive changes to the smell of your breath often alert doctors to liver disease. You should contact a doctor if you have fetor hepaticus. You may need tests to check your liver functions. Causes of Fetor Hepaticus The liver is the largest organ in your body. It is responsible for cleaning waste products out of your blood. Your liver acts as a filter and transforms certain substances in your blood into bile. That bile then goes into your intestines. You eventually excrete it in your feces. Your liver doesn’t filter out all the substances that it is supposed to when it isn’t working properly. One of the major effects of liver disease is that the liver may not filter out compounds that contain sulfur. This means they stay in your body and produce your fetor hepaticus. It indicates liver failure because it results from an increase of dimethyl sulfide in the air that you exhale. So liver failure results in this noticeable smell in your breath. Liver disease is a serious condition that requires medical treatment. It must be treated and won’t go away on its own. You should speak to a doctor about the situation as soon as you can. What Is Liver Disease? Liver disease is any condition tha...

Cirrhosis and bad breath, how are these two related? Bad breath is one of the various symptoms related to late-stage liver disease. If you experience bad breath due to cirrhosis of the liver, it is necessary to know what this says about your health. Fetor Hepaticus Breath of the dead or also known as Fetor Hepaticus is connected to severe liver disease and is one of the possible symptoms of cirrhosis of the liver. This condition is linked to high blood pressure within the liver vein that has been treated with a tube known as a portosystemic shunt (PSS). Fetor Hepaticus can also be related to various health conditions such as alcohol poisoning, diabetes, and brain disorders. It can also be due to complications related to cirrhosis. Symptoms The breath causes a unique smell described as an odd combination of garlic and rotten eggs. However, other people describe the scent as being a little sweet. There are other symptoms that people experience including: • Confusion (HE) • Yellowish skin (jaundice) • Stomach swelling ( • Easy bleeding • Swollen legs If you start experiencing them, visit your doctor immediately. What Causes It? Fetor hepaticus is caused by cirrhosis of the liver that causes portal hypertension. This situation makes it tough for blood to move through the liver resulting in a buildup in veins around the liver. When blood doesn’t move freely through the liver, it causes toxins to buildup in other body parts like the lungs. The unique smell could be the result of...

Fetor hepaticus, also called ‘breath of the dead’, is a condition in which the breath of the patient is sweetish, musty, and occasionally fecal in nature. It is associated with portal hypertension with portosystemic shunts. Portal Hypertension Portal hypertension is a condition in which the pressure in the portal vein is increased. This vein is a large one formed by the union of the superior mesenteric vein with the splenic vein. It drains blood from the intestinal mucosa, the spleen, and the pancreas, into the liver. This blood is rich in absorbed lipids and other molecules formed by the digestion of food. Inside the liver, there are sinusoids – these are blood channels lined by reticuloendothelial cells that contain blood received from the portal vein and the hepatic arteries. This blood drains into the hepatic veins and finally into the inferior vena cava, before returning to the right atrium of the heart. Common causes of portal hypertension include cirrhosis, most frequently due to alcohol abuse, as well as schistosomiasis in developing countries where the infestation is rife, and abnormalities of the hepatic vein. As a consequence of portal hypertension, anastomoses between the portal system and the systemic veins become dilated and tortuous – these are called portosystemic shunts. They are responsible for the development of dilated abdominal wall collaterals, radiating veins around the umbilicus (the ‘caput medusae’), esophageal varices, and dilated submucosal gastr...

• Van den Velde S, Nevens F, Van Hee P, van Steenberghe D, Quirynen M (November 2008). "GC-MS analysis of breath odor compounds in liver patients". J. Chromatogr. B. 875 (2): 344–8. • Kaji, H; Hisamura, M; Saito, N; Murao, M (May 1, 1978). "Gas chromatographic determination of volatile sulfur compounds in the expired alveolar air in hepatopathic subjects". Journal of Chromatography. 145 (3): 464–8. • Tangerman, A; Meuwese-Arends, MT; Jansen, JB (Feb 19, 1994). "Cause and composition of foetor hepaticus". Lancet. 343 (8895): 483. • Mitchell, S; Ayesh, R; Barrett, T; Smith, R (May 1999). "Trimethylamine and foetor hepaticus". Scandinavian Journal of Gastroenterology. 34 (5): 524–8. • Berend, Kenrick; deVries, A; Gans, R (October 9, 2014). "Physiological Approach to Assessment of Acid-Base Disturbances". New England Journal of Medicine. 371 (15): 1434–45.