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===Giant cell hepatitis===
=== Ischemic hepatitis ===
{{Main|Ischemic hepatitis}}


Injury to liver cells due to insufficient blood or oxygen results in ischemic hepatitis (or shock liver).<ref>{{cite web|title=Hepatic ischemia|url=http://www.nlm.nih.gov/medlineplus/ency/article/000214.htm|publisher=National Library of Medicine|accessdate=4 December 2013|author=Medline Plus|language=English|date=8/10/2012}}</ref> The condition is most often associated with [[heart failure]] but can also be caused by [[Shock (circulatory)|shock]] or [[sepsis]]. [[Blood testing]] of a person with ischemic hepatitis will show very high levels of [[Elevated_transaminases|transaminase enzymes]] ([[Aspartate transaminase|AST]] and [[Alanine transaminase|ALT]]). The condition usually resolves if the underlying cause is treated successfully. Ischemic hepatitis rarely causes permanent liver damage.<ref>{{cite book|title=Sleisenger and Fordtran's Gastrointestinal and Liver Disease|year=2010|publisher=Saunders|isbn=978-1416061892|url=http://www.mdconsult.com/books/page.do?eid=4-u1.0-B978-1-4160-6189-2..00083-4--s0085&isbn=978-1-4160-6189-2&type=bookPage&from=content&uniqId=431734887-1227|editor=Feldman, Friedman and Brandt|accessdate=4 December 2013|format=Online|chapter=Chapter 83 Vascular Diseases of the Liver}}</ref>
Giant cell hepatitis is a rare form of hepatitis that predominantly occurs in [[neonate|newborns]] and children. Diagnosis is made on the basis of the presence of [[Multinucleated|multinucleated]] hepatocyte [[Giant_cells|giant cells]].<ref>{{cite journal|last=Raj|first=S.|coauthors=Stephen, T.; Debski, R. F.|title=Giant Cell Hepatitis With Autoimmune Hemolytic Anemia: A Case Report and Review of Pediatric Literature|journal=Clinical Pediatrics|date=23 March 2011|volume=50|issue=4|pages=357–359|doi=10.1177/0009922810379501}}</ref> The cause of giant cell hepatitis is unknown but the condition is associated with viral infection, autoimmune disorders, and drug toxicity.


Cases presenting in adults are rare and tend to be rapidly progressive.<ref name=Hayashi2011>{{cite journal |author=Hayashi H, Narita R, Hiura M, ''et al.'' |title=A case of adult autoimmune hepatitis with histological features of giant cell hepatitis |journal=Intern. Med. |volume=50 |issue=4|pages=315–9 |year=2011 |pmid=21325763 |url=http://joi.jlc.jst.go.jp/JST.JSTAGE/internalmedicine/50.4063?from=PubMed|doi=10.2169/internalmedicine.50.4063}}</ref><ref name=Hartl2010>{{cite journal |author=Hartl J, Buettner R, Rockmann F,''et al.'' |title=Giant cell hepatitis: an unusual cause of fulminant liver failure |journal=Z Gastroenterol |volume=48|issue=11 |pages=1293–6 |year=2010 |month=November |pmid=21043007 |doi=10.1055/s-0029-1245476 |url=http://www.thieme-connect.com/DOI/DOI?10.1055/s-0029-1245476}}</ref><ref name=Gábor1997>{{cite journal |author=Gábor L, Pál K, Zsuzsa S|title=Giant cell hepatitis in adults |journal=Pathol. Oncol. Res. |volume=3 |issue=3 |pages=215–8 |year=1997|month=September |pmid=18470733 |doi=10.1007/BF02899924 |url=http://por.hu/1997/3/3/0215/0215a.pdf}}</ref><ref name=Alexopoulou2003>{{cite journal |author=Alexopoulou A, Deutsch M, Ageletopoulou J, ''et al.'' |title=A fatal case of postinfantile giant cell hepatitis in a patient with chronic lymphocytic leukaemia |journal=Eur J Gastroenterol Hepatol|volume=15 |issue=5 |pages=551–5 |year=2003 |month=May |pmid=12702915 |doi=10.1097/01.meg.0000050026.34359.7c|url=http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?issn=0954-691X&volume=15&issue=5&spage=551}}</ref><ref name=Bianchi1994>{{cite journal |author=Bianchi L, Terracciano LM |title=[Giant cell hepatitis in adults] |language=German |journal=Praxis (Bern 1994) |volume=83 |issue=44 |pages=1237–41|year=1994 |month=November |pmid=7973279 }}</ref> The cause is currently unknown but an infectious cause is suspected.<ref name="pmid15615251">{{cite journal |author=Duhaut P, Bosshard S, Ducroix JP |title=Is giant cell arteritis an infectious disease? Biological and epidemiological evidence |journal=Presse Médicale (Paris, France : 1983) |volume=33 |issue=19 Pt 2|pages=1403–8 |year=2004 |month=November |pmid=15615251 |doi=10.1016/S0755-4982(04)98939-7}}</ref><ref name=Shet1998>{{cite journal |author=Shet TM, Kandalkar BM, Vora IM |title=Neonatal hepatitis--an autopsy study of 14 cases|journal=Indian J Pathol Microbiol |volume=41 |issue=1 |pages=77–84 |year=1998 |month=January |pmid=9581081 }}</ref> The condition tends to improve with the use of [[ribivirin]] suggesting a viral origin.<ref name=Hassoun2000>{{cite journal|author=Hassoun Z, N'Guyen B, Cote J, ''et al.'' |title=A case of giant cell hepatitis recurring after liver transplantation and treated with ribavirin |journal=Can. J. Gastroenterol. |volume=14 |issue=8 |pages=729–31 |year=2000|month=September |pmid=11185540 |url=http://www.pulsus.com/journals/abstract.jsp?sCurrPg=journal&jnlKy=2&atlKy=5390&isuKy=200&isArt=t}}</ref><ref name=Durand1997>{{cite journal |author=Durand F, Degott C, Sauvanet A, ''et al.'' |title=Subfulminant syncytial giant cell hepatitis: recurrence after liver transplantation treated with ribavirin |journal=J. Hepatol. |volume=26 |issue=3 |pages=722–6 |year=1997 |month=March |pmid=9075682|doi=10.1016/S0168-8278(97)80440-0}}</ref> Hepatitis E,<ref name="pmid17410455">{{cite journal |author=Harmanci O, Onal IK, Ersoy O, Gürel B, Sökmensüer C, Bayraktar Y |title=Postinfantile giant cell hepatitis due to hepatitis E virus along with the presence of autoantibodies |journal=Digestive Diseases and Sciences |volume=52 |issue=12 |pages=3521–3 |year=2007|month=December |pmid=17410455 |doi=10.1007/s10620-006-9698-8}}</ref> hepatitis C,<ref name="pmid16949926">{{cite journal|author=Moreno A, Moreno A, Pérez-Elías MJ, Quereda C, Fernández-Muñoz R, Antela A, Moreno L, Bárcena R, López-San Román A, Celma ML, García-Martos M, Moreno S |title=Syncytial giant cell hepatitis in human immunodeficiency virus-infected patients with chronic hepatitis C: 2 cases and review of the literature |journal=Human Pathology |volume=37 |issue=10|pages=1344–9 |year=2006 |month=October |pmid=16949926 |doi=10.1016/j.humpath.2006.05.003 }}</ref> paramyxovirus,<ref name=Fimmel1993>{{cite journal |author=Fimmel CJ, Guo L, Compans RW, ''et al.'' |title=A case of syncytial giant cell hepatitis with features of a paramyxoviral infection |journal=Am. J. Gastroenterol. |volume=93 |issue=10 |pages=1931–7|year=1998 |month=October |pmid=9772058 |doi=10.1111/j.1572-0241.1998.00548.x }}</ref><ref name=Krech1998>{{cite journal|author=Krech RH, Geenen V, Maschek H, Högemann B |title=[Adult giant cell hepatitis with fatal outcome. Clinicopathologic case report and reflections on pathogenesis] |language=German |journal=Pathologe |volume=19 |issue=3 |pages=221–5|year=1998 |month=May |pmid=9648148 |url=http://link.springer.de/link/service/journals/00292/bibs/8019003/80190221.htm|doi=10.1007/s002920050277}}</ref><ref name=Koff1991>{{cite journal |author=Koff RS |title=Acute and chronic giant cell hepatitis: a paramyxovirus infection? |journal=Gastroenterology |volume=101 |issue=3 |pages=863–4 |year=1991|month=September |pmid=1860651 }}</ref><ref name=Phillips1991>{{cite journal |author=Phillips MJ, Blendis LM, Poucell S,''et al.'' |title=Syncytial giant-cell hepatitis. Sporadic hepatitis with distinctive pathological features, a severe clinical course, and paramyxoviral features |journal=N. Engl. J. Med. |volume=324 |issue=7 |pages=455–60 |year=1991|month=February |pmid=1988831 |doi=10.1056/NEJM199102143240705 }}</ref> papillomavirus<ref name=Drut1998>{{cite journal|author=Drut R, Gómez MA, Drut RM, Cueto RE, Lojo M |title=[Human papillomavirus, neonatal giant cell hepatitis and biliary duct atresia] |language=Spanish; Castilian |journal=Acta Gastroenterol. Latinoam. |volume=28 |issue=1 |pages=27–31|year=1998 |pmid=9607071 }}</ref><ref name=Drut1996>{{cite journal |author=Drut R, Gómez MA, Drut RM, Lojo MM |title=Human papillomavirus (HPV)-associated neonatal giant cell hepatitis (NGCH) |journal=Pediatr Pathol Lab Med |volume=16 |issue=3|pages=403–12 |year=1996 |pmid=9025842 }}</ref> and Human herpes virus 6<ref name=Potenza2008>{{cite journal|author=Potenza L, Luppi M, Barozzi P, ''et al.'' |title=HHV-6A in syncytial giant-cell hepatitis |journal=N. Engl. J. Med. |volume=359 |issue=6 |pages=593–602 |year=2008 |month=August |pmid=18687640 |doi=10.1056/NEJMoa074479 }}</ref><ref name=Kuntzen2005>{{cite journal |author=Kuntzen T, Friedrichs N, Fischer HP, Eis-Hübinger AM, Sauerbruch T, Spengler U|title=Postinfantile giant cell hepatitis with autoimmune features following a human herpesvirus 6-induced adverse drug reaction |journal=Eur J Gastroenterol Hepatol |volume=17 |issue=10 |pages=1131–4 |year=2005 |month=October |pmid=16148562|url=http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?issn=0954-691X&volume=17&issue=10&spage=1131 |doi=10.1097/00042737-200510000-00020}}</ref> have been suggested as causes. A similar condition has been reported in cats but it is not known if there is any connection between these conditions.<ref name=Suzuki2001>{{cite journal |author=Suzuki K, Nakayama H, Doi K |title=Giant cell hepatitis in two young cats|journal=J. Vet. Med. Sci. |volume=63 |issue=2 |pages=199–201 |year=2001 |month=February |pmid=11258461|url=http://joi.jlc.jst.go.jp/JST.JSTAGE/jvms/63.199?lang=en&from=PubMed |doi=10.1292/jvms.63.199}}</ref>


== Diagnosis ==
== Diagnosis ==

Revision as of 20:32, 4 December 2013

Ischemic hepatitis

Main article: Ischemic hepatitis

Injury to liver cells due to insufficient blood or oxygen results in ischemic hepatitis (or shock liver).[1] The condition is most often associated with heart failure but can also be caused by shock or sepsis. Blood testing of a person with ischemic hepatitis will show very high levels of transaminase enzymes (AST and ALT). The condition usually resolves if the underlying cause is treated successfully. Ischemic hepatitis rarely causes permanent liver damage.[2]

Diagnosis

Diagnosis is made by assessing an individual's symptoms, physical exam findings, medical history, risk-factors, drug and medication use, and, possibly, in conjunction with blood tests and liver biopsy. Blood testing includes blood chemistry, liver enzymes, and serology.[3]

and specific patterns of abnormality may indicate certain etiologies or stages of hepatitis. However, these lab values may be normal in individuals with hepatitis and elevated in

The colloquial liver-function test panel encompasses a variety of serum chemistry markers used to evaluate liver function. While specific patterns of abnormality may be indicative of certain etiologies or stages of hepatitis, results may be abnormal in otherwise healthy people or normal in individuals with hepatitis.

Hepatitis A

Hepatitis A[4]
Marker Detection Time Description Significance
Faecal HAV 2–4 weeks or 28days - Early detection
Ig M anti HAV 4–12 weeks Enzyme immunoassay for antibodies During Acute Illness
Ig G anti HAV 5 weeks - persistent Enzyme immunoassay for antibodies Old infection or Reinfection

Hepatitis C

Marker Detection Time Description Significance Note
HCV-RNA 1–3 weeks or 21 days PCR Demonstrates presence or absence of virus Results may be intermittent during course of infection. Negative result is not indicative of absence.
anti-HCV 5–6 weeks Enzyme Immunoassay for antibodies Demonstrates past or present infection High false positive in those with autoimmune disorders and populations with low virus prevalence.
ALT 5–6 weeks - Peak in ALT coincides with peak in anti-HCV Fluctuating ALT levels is an indication of active liver disease.

Data taken from the WHO website on Hepatitis C.[5]

Differential diagnosis

Several diseases can present with signs, symptoms, and/or liver function test abnormalities similar to hepatitis. In severe cases of alpha 1-antitrypsin deficiency (A1AD), excess protein in liver cells causes and inflammation and cirrhosis.[6] Some metabolic disorders cause damage to the liver through a variety of mechanisms. In hemochromatosis and Wilson's disease toxic accumulation of dietary minerals results in inflammation and cirrhosis.[7]

Screening

A recently completed high-quality study evaluating the utility of these tests found that [8]

  1. ^ Medline Plus (8/10/2012). "Hepatic ischemia". National Library of Medicine. Retrieved 4 December 2013. {{cite web}}: Check date values in: |date= (help)
  2. ^ Feldman, Friedman and Brandt, ed. (2010). "Chapter 83 Vascular Diseases of the Liver". Sleisenger and Fordtran's Gastrointestinal and Liver Disease (Online). Saunders. ISBN 978-1416061892. Retrieved 4 December 2013.
  3. ^ Green, RM (2002 Oct). "AGA technical review on the evaluation of liver chemistry tests". Gastroenterology. 123 (4): 1367–84. PMID 12360498. {{cite journal}}: Check date values in: |date= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)
  4. ^ "Acute Viral Hepatitis : Introduction Harrison's Principle of Internal Medicine, 17 Edition".
  5. ^ "WHO | Hepatitis C". Who.int. 2010-12-08. Retrieved 2012-08-26.
  6. ^ Stoller, James K (2005). "α1-antitrypsin deficiency". The Lancet. 365 (9478): 2225–2236. doi:10.1016/S0140-6736(05)66781-5. {{cite journal}}: |access-date= requires |url= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)
  7. ^ Hansen, Keli (2008). "Metabolic liver disease in children". Liver Transplantation. 14 (5): 713–733. doi:10.1002/lt.21520. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)
  8. ^ Lilford, RJ (2013 Jul). "Birmingham and Lambeth Liver Evaluation Testing Strategies (BALLETS): a prospective cohort study". Health technology assessment (Winchester, England). 17 (28): i–xiv, 1–307. PMID 23834998. {{cite journal}}: Check date values in: |date= (help); Unknown parameter |coauthors= ignored (|author= suggested) (help)
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