Fetor Hepaticus 'Breath of the Dead'

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 / Shutterstock

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 collaterals, radiating veins around the umbilicus (the ‘caput medusae’), esophageal varices, and dilated submucosal gastric and rectal plexus veins.

Results of portal hypertension

As a result of portosystemic shunting, certain volatile sulfur compounds (chiefly thiols) and some ketones pass directly into the systemic circulation, bypassing the liver. This means that these chemicals reach the lungs without first undergoing hepatic metabolism. As a result, these volatile chemicals are exhaled in the breath.

Substances that cause fetor hepaticus

Some of the substances that cause fetor hepaticus include dimethyl sulfide, acetone, 2-butanone, and 2-pentanone, all of which are found in higher concentrations in the blood of liver disease patients. Some research points to dimethyl sulfide being the primary odor-producing component in the breath of fetor hepaticus. Testing for dimethyl sulfide may therefore assist in determining the possibility of hepatocellular failure.

Trimethylamine is also increased in many patients with cirrhosis and may contribute to the odor of the breath. Another chemical that could potentially be involved in fetor hepaticus is ammonia.

Conditions associated with fetor hepaticus

Fetor hepaticus is a late sign of hepatocellular failure and indicates the onset of hepatic encephalopathy, a condition in which the consciousness is affected along with other motor parameters, by the elevated levels of toxic substances in the brain. Other conditions associated with fetor hepaticus include diabetic ketoacidosis, and isopropyl alcohol poisoning.

References

Further Reading

Last Updated: Mar 17, 2021

Dr. Liji Thomas

Written by

Dr. Liji Thomas

Dr. Liji Thomas is an OB-GYN, who graduated from the Government Medical College, University of Calicut, Kerala, in 2001. Liji practiced as a full-time consultant in obstetrics/gynecology in a private hospital for a few years following her graduation. She has counseled hundreds of patients facing issues from pregnancy-related problems and infertility, and has been in charge of over 2,000 deliveries, striving always to achieve a normal delivery rather than operative.

Citations

Please use one of the following formats to cite this article in your essay, paper or report:

  • APA

    Thomas, Liji. (2021, March 17). Fetor Hepaticus 'Breath of the Dead'. News-Medical. Retrieved on July 27, 2021 from https://www.news-medical.net/health/Fetor-Hepaticus-Breath-of-the-Dead.aspx.

  • MLA

    Thomas, Liji. "Fetor Hepaticus 'Breath of the Dead'". News-Medical. 27 July 2021. <https://www.news-medical.net/health/Fetor-Hepaticus-Breath-of-the-Dead.aspx>.

  • Chicago

    Thomas, Liji. "Fetor Hepaticus 'Breath of the Dead'". News-Medical. https://www.news-medical.net/health/Fetor-Hepaticus-Breath-of-the-Dead.aspx. (accessed July 27, 2021).

  • Harvard

    Thomas, Liji. 2021. Fetor Hepaticus 'Breath of the Dead'. News-Medical, viewed 27 July 2021, https://www.news-medical.net/health/Fetor-Hepaticus-Breath-of-the-Dead.aspx.

Comments

  1. Medventura medicals Medventura medicals India says:

    well define of Results of Portal Hypertension

The opinions expressed here are the views of the writer and do not necessarily reflect the views and opinions of News Medical.