Hepatic disease cholestatic

Except for one case/° recent clinically oriented MRS studies of human liver have been at 1.5T. Several studies applied in vivo MRS to diffuse liver disease. ° °" The PDE intensity was lower in cirrhosis than in controls ° and served to distinguish the alcoholic, viral, and cholestatic etiologies of diffuse liver disease. ° However, there was no difference between patients with non-alcoholic fatty liver disease (NAFLD) and controls. Sharma et al., using the relative PME intensity as a measure of altered gluconeogenesis (this peak can contain glucose-6-P and 3-phos-phoglycerate in addition to PC and PE), found that hepatic gluconeogenesis was altered in both obese and non-obese Asian Indians with NAFLD, relative to non-obese subjects without NAFLD. 

Erythropoietic porphyrias The erythropoietic porphyrias (congenital erythropoietic porphyria and erythropoietic proto porphyria) are characterized by skin rashes and blisters lhat appear in early childhood. The diseases are complicated by cholestatic liver cirrhosis and progressive hepatic failure. 

Danazol is a weak androgen and also has a series of other hormonal and anti-hormonal properties. It inhibits pituitary gonadotropin and has been used in the treatment of endometriosis, fibrocystic disease of the breast, idiopathic thrombocytopenic purpura, and hereditary angioedema. Its hepatotoxic effects include reversible rises in serum transaminases and cholestatic hepatitis a few cases of hepatocellular tumors have been reported. 

Of 14 cases of suspected drug-induced liver disease presenting to a gastroenterology department over a 3-year period, one was thought to be related to thiamazole, with a hepatitic pattern of liver function tests in a 39-year-old woman 6 days after the start of therapy recovery was swift and complete (48). Delayed cholestatic hepatitis without antineutrophil cytoplasmic antibodies has been reported (49), and there have been fatal cases of hepatic necrosis (SEDA-21, 438) (7). 

A 33-year-old woman developed acute pancreatitis together with mild cholestatic hepatitis and erythema nodosum 1 month after starting carbimazole for Graves disease rechallenge with a single dose of carbimazole (10 mg) 7 days after initial recovery led to a further episode of acute pancreatitis, from which she recovered (54). 

Niacin and acipimox should be relatively safe to use in the absence of varices, gastritis, coagulopathy, thrombocytopenia or a history of decompensation. Both can cause pruritus, which is common in cholestatic liver disease. The extended release formulation of niacin (Niaspan Prolonged Release) may cause hepatitis and LFTs should be monitored. 

It is less likely in other forms of liver disease, such as acute hepatitis and cirrhosis. Cirrhosis may actually protect against atherosclerosis [5, 8, 9]. The reasons for this are not clear. Secondary hypercholesterolaemia frequently occurs in cholestatic conditions, but usually does not require treatment [10]. Other risk factors for hyperlipidaemia and cardiovascular disease should be assessed, as their presence may independently indicate a need for medical intervention [9]. In PBC, patients with severe, chronic disease do not appear to have an increased cardiovascular risk as a result of their hypercholesterolaemia this may be due to the presence of cirrhosis. In contrast, in less severe PBC... 

Adverse reactions. Erythromycin is remarkably nontoxic, but the estolate can cause cholestatic hepatitis with abdominal pain and fever which may be confused with viral hepatitis, acute cholecystitis or acute pancreatitis. This is probably an allergy, and recovery is usual but the estolate should not be given to a patient with liver disease. Other allergies are rare. Gastrointestinal disturbances occur frequently (up to 28%), particularly diarrhoea and nausea, but, with the antibacterial spectrum being narrower than with tetracycline, opportunistic infection is less troublesome. 

Hormone preparations. Use of contraceptives should be monitored carefully in patients with cholestatic liver disease, because jaimdice may be exacerbated continued use of oral contraceptives during an attack of acute hepatitis can have the same effect. Low oestrogen preparations carry less risk of this complication. 

Infective hepatitis, until 3 months after liver function tests have become normal, and other liver disease including disturbances of hepatic excretion, e.g. cholestatic jaundice, Dubin-Johnson and Rotor s3mdromes... 

Elevated LAP values are found predominantly in biliary and cholestatic diseases - in accordance with AP. In liver diseases due to alcohol abuse, LAP values are exhibited both more frequently and with higher values than AP. In hepatitis mononucleosa, LAP is generally also more clearly elevated than AP. Significant increases in LAP are found in pancreatic and breast cancer as well as in collagenoses of the vascular type. LAP is not found in bone there is no evidence of elevated LAP in bone diseases. Normal LAP in connection with an increase in AP consequently rules out hepatobiliary diseases and requires further investigation. In these cases, parallel determination of AP and LAP is advisable. 

The cholestatic course of disease (W. Siede, 1942) is largely identical to the periacinal form of icterus catarrhalis (H. Eppinger, 1937), cholangiolitic hepatitis (C.J. Watson et al., 1946), hepatitis with intrahepatic obstruction (I. Magyar, 1953) and hepatitis with a cholestatic element (H. Kalk, 1957). 

Those forms of acute viral hepatitis that have a normal clinical course also present discrete quantities of bile to be found as intraepithelial drops and intercellular cylinders or deposits in the stellate cells. These findings cannot be confirmed biochemically. A cholestatic course of disease is occasionally witnessed with a marked increase in alkaline phosphatase, particularly in older patients and in women. It is mostly accompanied by jaundice. The... 

This virus species derived its name from the town of Coxsackie in the state of New York, where virological evidence thereof was successfully obtained for the first time. Coxsackie viruses are assigned to the picornavirus group, consisting at present of 23 A and 6 B types. Coxsackie hepatitis with mesenchymal reactions, portal infiltration and focal hepatocellular necrosis sometimes occurs, especially in infants. Cholestatic, predominantly centrolobular forms of the disease, can develop in adults. A lethal course is extremely rare. (66-68) The course of infection with the Coxsackie type B4 or B5 virus may give rise to the Fitz-Hugh-Curtis syndrome with the development of the typical violin string-like adhesive strands. (65) (s. fig. 24.2)... 

Imaging techniques (with the exception of ERC, e. g. in PSC) are generally of no diagnostic value in chronic hepatitis prior to the development of cirrhosis. Sonography is regarded as a basic, routine examination and is always indicated in cholestatic diseases or suspected cirrhosis. (9) There is often evidence of abdominal lymphadenopathy (especially of the hepatoduodenal ligament), which points to a more severe histological... 

Lefkowitch, J.H., Falkow, S., Whitlock, R.T. Hepatic Hodgkin s disease simulating cholestatic hepatitis with liver failure. Arch. Pathol. Lab. Med. 1985 109 424-426... 

More severe liver disease, presenting as hepatitis and/ or intrahepatic cholestasis, has been seen with beta-lactam antibiotics of various classes, the isoxazolyl penicillins being most frequently involved. Co-amoxiclav has repeatedly been associated with cholestatic hepatitis. 

Several case reports have demonstrated that penicillamine can cause hver damage (SEDA-13, 199) (184), mainly cholestatic hepatitis, often associated with other signs of hypersensitivity such as fever, rash (185), and pulmonary (159,186) or hematological reactions (162). In two children with Wilson s disease, penicillamine was thought to have caused persistence of a pre-existing increase in aminotransferase activity (187). 

---