Voluntary Reviewers:- Dr. Manoj Kumar Sharma MD,DM and Dr. Praveen Sharma MD, DM
The Institute of Liver and Biliary Sciences, New Delhi, India.
Overview of Non-Viral Liver Diseases
Non Viral Hepatitis is classified as toxic or drug-induced (idiosyncratic) hepatitis, non viral hepatitis
is an inflammation of the liver. Most patients recover from this illness, although a few develop
fulminating hepatitis or cirrhosis.
Non viral hepatitis results from various causes:
|Causes of Non Viral Hepatitis
Alcohol Overuse leading to inflammation of the liver. Continued alcohol intake could have severe effects
such as cirrhosis and liver cancer
Direct Hepatotoxicity leading to hepato-cellular damage and necrosis, usually caused by toxins.
This could be from dose-dependent drugs and
especially acetaminophen (trade name: Paracetamol, crocin, tylenlol) overdose.
Idiosyncratic Hepatotoxicity typically follows from a sensitization period of several weeks caused
from hypersensitivity to medications
(for example, isoniazid, methyldopa, mercaptopurine, lovastatin, pravastatin, dipyridamole, and halothane)
Cholestatic Reactions occurring from lack of bile excretion. This may possibly be a direct hepatotoxicity
from oral contraceptives or steroids; a hypersensitivity to phenothiazine derivatives such as chlorpromazine,
antibiotics; thyroid medications, anti diabetic drugs; and cytotoxic drugs
Metabolic and Autoimmune Disorders arising from acute increase in severity of a
sub clinical liver disease, such as autoimmune hepatitis and Wilson's disease.
Infection from parasite, fungal and bacterial invasion. The liver's dual blood supply makes
it uniquely susceptible to infection. Blood is received from the intestinal tract via the
hepatic portal system and sustained by systemic circulation via the hepatic artery.
Because of this unique perfusion, the liver may be frequently exposed to systemic or intestinal infections
or the mediators of causing toxicity. The biliary tree (central bile duct and gall bladder)
provide a further conduit for gut bacteria or parasites to access the liver parenchyma.
Clinical features of toxic and drug-induced hepatitis vary with the severity of liver damage
and the causative agent. In most patients, symptoms resemble those of
- Viral hepatitis
- Dark urine
- Abdominal pain (with acute onset and massive necrosis)
- Clay-colored stools
- Cholestatic form of hepatitis
Diagnostic findings include elevations in
|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 /right-upper-quadrant pain.
- Serum aspartate aminotransferase
- Alanine aminotransferase
- Total and direct bilirubin (with cholestasis)
- Alkaline phosphatase levels
- White blood cell (WBC) count
- Eosinophil count (possible in the drug-induced type).
A liver biopsy may help identify the underlying pathology, especially infiltration with WBC's and eosinophils.
Liver function tests have limited value in distinguishing between non viral and viral hepatitis a reason why
viral markers are recommended.
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 prescribed for patients with drug-induced hepatitis.
To prevent non-viral hepatitis, teach the patient the proper use of drugs and the proper handling of cleaning agents
List of Non Viral Diseases
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