Hepatitis, nonviral

Hepatitis, nonviral: Excerpt from Handbook of Diseases

Classified as toxic or drug-induced (idiosyncratic) hepatitis, nonviral hepatitis is an inflammation of the liver. Most patients recover from this illness, although a few develop fulminating hepatitis or cirrhosis.

Causes

Nonviral hepatitis results from various causes, including:

❑ alcohol overuse — follows heavy alcohol consumption

❑ direct hepatotoxicity — hepatocellular damage and necrosis usually caused by toxins; it’s dose-dependent and occurs primarily in connection with acetaminophen overdose

❑ idiosyncratic hepatotoxicity — follows a sensitization period of several weeks; caused by a host hypersensitivity to medications (isoniazid, methyldopa, mercaptopurine, lovastatin, pravastatin, dipyridamole, and halothane)

❑ cholestatic reactions — caused by lack of bile excretion; possibly direct hepatotoxicity from hormonal contraceptives or anabolic steroids; hypersensitivity to phenothiazine derivatives, such as chlorpromazine, antibiotics, thyroid medications, antidiabetic drugs, and cytotoxic drugs

❑ metabolic and autoimmune disorders — acute exacerbations of subclinical liver disease, such as autoimmune hepatitis and Wilson’s disease

❑ infectious agents — systemic viruses, such as cytomegalovirus, mononucleosis or Epstein-Barr virus, measles virus, varicella zoster, adenovirus, herpes simplex virus, coxsackievirus, and human immunodeficiency virus; spirochetes such as those that cause syphilis and leptospirosis.

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, symptoms resemble those of viral hepatitis: anorexia, nausea, vomiting, jaundice, dark urine, hepatomegaly, possibly abdominal pain (with acute onset and massive necrosis), clay-colored stools, and pruritus with the cholestatic form of hepatitis.

Clinical tip  Carbon tetrachloride poisoning also produces headache, dizziness, drowsiness, and vasomotor collapse; halothane-related hepatitis produces fever, moderate leukocytosis, and eosinophilia; chlorpromazine produces a rash, abrupt fever, arthralgias, lymphadenopathy, and epigastric or right upper quadrant pain.

Diagnosis

Diagnostic findings include elevations in serum aspartate aminotransferase, alanine aminotransferase, both total and direct bilirubin (with cholestasis), and alkaline phosphatase levels; white blood cell (WBC) count; and eosinophil count (possible in the drug-induced type).

A 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 hep-atitis caused by other substances.

Corticosteroids may be prescribed for patients with drug-induced hepatitis.

Special considerations

To prevent nonviral hepatitis, teach the patient the proper use of drugs and the proper handling of cleaning agents and solvents.

Book Source Details

• Book Title: Handbook of Diseases
• Author(s): Springhouse
• Year of Publication: 2003
• Copyright Details: Handbook of Diseases, Copyright © 2003 Lippincott Williams & Wilkins.

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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.

More About This Book: Title: Handbook of Diseases Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2003 ISBN: 1-58255-266-5

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