Difference between revisions of "Medical liver disease"

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Medical liver disease (view source)

Revision as of 15:02, 5 September 2014

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→‎Drug-induced liver disease: split out
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==Drug-induced liver disease==
==Drug-induced liver disease==
{{Main|Drug toxicity}}
*[[AKA]] ''drug-induced liver toxicity''.
*[[AKA]] ''drug-induced liver toxicity''.
===General===
{{Main|Drug-induced liver disease}}
*Drugs can do almost anything; may include: [[granulomata]], bile duct loss, cholestasis, ischemic type injury.
*Effects can be delayed -- temporal relationship not always obvious.
 
===Microscopic===
Features:
*Non-specific findings.
**+/-Eosinophils<ref>{{Ref DCHH|166}}</ref> - '''significant suggestive finding'''.
**+/-Steatosis - periportal macrovesicular, microvesicular.
**+/-[[Vanishing bile duct syndrome]].
**+/-[[Granuloma]]s.
 
====Images====
<gallery>
Image:Drug-induced_hepatitis_low_mag.jpg | Drug-induced hepatitis - low mag. (WC)
Image:Drug-induced_hepatitis_intermed_mag.jpg | Drug-induced hepatitis - intermed. mag. (WC)
Image:Drug-induced hepatitis high mag.jpg | Drug-induced hepatitis - high mag. (WC)
</gallery>
 
====Specific patterns====
Acute hepatits:
*Related to Rx - most often antibiotics.
 
[[Steatohepatitis]]/[[steatosis]]:<ref name=pmid16237810>{{Cite journal  | last1 = Grieco | first1 = A. | last2 = Forgione | first2 = A. | last3 = Miele | first3 = L. | last4 = Vero | first4 = V. | last5 = Greco | first5 = AV. | last6 = Gasbarrini | first6 = A. | last7 = Gasbarrini | first7 = G. | title = Fatty liver and drugs. | journal = Eur Rev Med Pharmacol Sci | volume = 9 | issue = 5 | pages = 261-3 | month =  | year =  | doi =  | PMID = 16237810 }}</ref>
*Amiodarone - cardiac arrhythmias.
*Tamoxifen - [[breast cancer]].
*Carbamazepine - seizures.
 
[[Cholestasis]]:
*Venlafaxine - depression.<ref name=pmid23073329>{{Cite journal  | last1 = Stadlmann | first1 = S. | last2 = Portmann | first2 = S. | last3 = Tschopp | first3 = S. | last4 = Terracciano | first4 = LM. | title = Venlafaxine-induced cholestatic hepatitis: case report and review of literature. | journal = Am J Surg Pathol | volume = 36 | issue = 11 | pages = 1724-8 | month = Nov | year = 2012 | doi = 10.1097/PAS.0b013e31826af296 | PMID = 23073329 }}</ref>
*Thalidomide - [[multiple myeloma]].<ref name=pmid22789729>{{Cite journal  | last1 = Vilas-Boas | first1 = F. | last2 = Gonçalves | first2 = R. | last3 = Sobrinho Simões | first3 = M. | last4 = Lopes | first4 = J. | last5 = Macedo | first5 = G. | title = Thalidomide-induced acute cholestatic hepatitis: case report and review of the literature. | journal = Gastroenterol Hepatol | volume = 35 | issue = 8 | pages = 560-6 | month = Oct | year = 2012 | doi = 10.1016/j.gastrohep.2012.05.007 | PMID = 22789729 }}</ref>
 
====Specific drugs====
Acetaminophen:
*Zone 3 necrosis.
**Tx: N-acetylcysteine (NAC).<ref name=pmid19621836>{{cite journal |author=Millea PJ |title=N-acetylcysteine: multiple clinical applications |journal=Am Fam Physician |volume=80 |issue=3 |pages=265–9 |year=2009 |month=August |pmid=19621836 |doi= |url=}}</ref>
***NAC is an endogenous precursor to glutathione.<ref>URL: [http://www.mskcc.org/mskcc/html/69310.cfm http://www.mskcc.org/mskcc/html/69310.cfm]. Accessed on: 19 October 2010.</ref>
**Hepatotoxicity from ''N-acetyl-p-benzoquinoneimine (NAPQI)'' due to depletion of ''glutathione''.<ref name=pmid19621836>{{cite journal |author=Millea PJ |title=N-acetylcysteine: multiple clinical applications |journal=Am Fam Physician |volume=80 |issue=3 |pages=265–9 |year=2009 |month=August |pmid=19621836 |doi= |url=}}</ref>
 
Methotrexate - chronic use:
*Histology:<ref>{{Ref MacSween|715}}</ref>
**Features of steatohepatitis.
***Zone III steatosis.
***Ballooning degeneration.
**Portal inflammation with mixed population (lymphocytes, macrophages, PMNs).
**Nuclear atypia (hyperchromasia, pleomorphism, vacuolation).
***Described as just nuclear size variation by some.<ref>MG. 23 September 2009.</ref>
 
===Sign out===
<pre>
LIVER, MEDICAL CORE BIOPSIES:
- MILD STEATOHEPATITIS AND MILD FIBROSIS (1/4).
- MILD TO MODERATE STEATOSIS.
 
COMMENT:
The findings are compatible with nonalcoholic steatohepatitis (NASH), alcoholic
steatohepatitis (ASH) or drug effect. The steatosis is periportal predominant; this
is not typical for NASH or ASH. Clinical correlation and review of medications
is suggested.
</pre>


==Focal nodular hyperplasia==
==Focal nodular hyperplasia==
Michael
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