Nonviral hepatitis
Nonviral hepatitis: Excerpt from Professional Guide to Diseases (Eighth Edition)
Nonviral inflammation of the liver (toxic or drug-induced hepatitis) is a form of hepatitis that usually results from exposure to certain chemicals or drugs. Most patients recover from this illness, although a few develop fulminating hepatitis or cirrhosis.
Causes
Various hepatotoxins — carbon tetrachloride, acetaminophen, trichloroethylene, poisonous mushrooms, and vinyl chloride — can cause the toxic form of this disease. Following exposure to these agents, liver damage usually occurs within 24 to 48 hours, depending on the size of the dose or degree of exposure. Alcohol, anoxia, and preexisting liver disease exacerbate the toxic effects of some of these agents.
Drug-induced (idiosyncratic) hepatitis may stem from a hypersensitivity reaction unique to the affected individual, unlike toxic hepatitis, which appears to affect all people indiscriminately. Among the drugs that may cause this type of hepatitis are niacin, halothane, sulfonamides, isoniazid, methyldopa, and phenothiazines (cholestasis-induced hepatitis). In hypersensitive people, symptoms of hepatic dysfunction may appear at any time during or after exposure to these drugs but usually emerge after 2 to 5 weeks of therapy. Not all adverse drug reactions are toxic. Hormonal contraceptives, for example, may impair liver function and produce jaundice without causing necrosis, fatty infiltration of liver cells, or hypersensitivity.
Signs and symptoms
Clinical features of toxic and drug-induced hepatitis vary with the severity of the liver damage and the causative agent. In most patients, signs and symptoms resemble those of viral hepatitis: anorexia, nausea, vomiting, jaundice, dark urine, hepatomegaly, possible abdominal pain (with acute onset and massive necrosis), and clay-colored stools or pruritus with the cholestatic form of hepatitis. Carbon tetrachloride poisoning also produces headache, dizziness, drowsiness, and vasomotor collapse; halothane-related hepatitis produces fever, moderate leukocytosis, and eosinophilia; chlorpromazine toxicity produces abrupt fever, rash, arthralgia, lymphadenopathy, and epigastric or right upper quadrant pain.
Diagnosis
Diagnostic findings include elevations in serum aspartate aminotransferase and alanine aminotransferase, total and direct bilirubin (with cholestasis), alkaline phosphatase, white blood cell (WBC) count, and eosinophil count (possible in drug-induced type). Liver biopsy may help identify the underlying pathology, especially infiltration with WBCs and eosinophils. Liver function tests have limited value in distinguishing between nonviral and viral hepatitis.
Treatment
Effective treatment must remove the causative agent by lavage, catharsis, or hyperventilation, depending on the route of exposure. Acetylcysteine may serve as an antidote for toxic hepatitis caused by acetaminophen poisoning but doesn’t prevent drug-induced hepatitis caused by other substances. Corticosteroids may be ordered for patients with the drug-induced type.
Special considerations
❑ Monitor laboratory studies and note trends.
❑ Monitor the patient’s vital signs and provide support to maintain vital functioning, depending on the severity of his symptoms.
❑ Preventive measures should include instructing the patient about the proper use of drugs and the proper handling of cleaning agents and solvents.
Book Source Details
- Book Title: Professional Guide to Diseases (Eighth Edition)
- Author(s): Springhouse
- Year of Publication: 2005
- Copyright Details: Professional Guide to Diseases (Eighth Edition), Copyright © 2005 Lippincott Williams & Wilkins.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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