tailieunhanh - Chapter 043. Jaundice (Part 6)

Hepatocellular Conditions Hepatocellular diseases that can cause jaundice include viral hepatitis, drug or environmental toxicity, alcohol, and end-stage cirrhosis from any cause (Table 43-2). Wilson's disease, once believed to occur primarily in young adults, should be considered in all adults if no other cause of jaundice is found. Autoimmune hepatitis is typically seen in young to middle-aged women but may affect men and women of any age. Alcoholic hepatitis can be differentiated from viral and toxin-related hepatitis by the pattern of the aminotransferases. Patients with alcoholic hepatitis typically have an AST:ALT ratio of at least 2:1. The AST rarely exceeds 300. | Chapter 043. Jaundice Part 6 Hepatocellular Conditions Hepatocellular diseases that can cause jaundice include viral hepatitis drug or environmental toxicity alcohol and end-stage cirrhosis from any cause Table 43-2 . Wilson s disease once believed to occur primarily in young adults should be considered in all adults if no other cause of jaundice is found. Autoimmune hepatitis is typically seen in young to middle-aged women but may affect men and women of any age. Alcoholic hepatitis can be differentiated from viral and toxin-related hepatitis by the pattern of the aminotransferases. Patients with alcoholic hepatitis typically have an AST ALT ratio of at least 2 1. The AST rarely exceeds 300 U L. Patients with acute viral hepatitis and toxin-related injury severe enough to produce jaundice typically have aminotransferases 500 U L with the ALT greater than or equal to the AST. The degree of aminotransferase elevation can occasionally help in differentiating between hepatocellular and cholestatic processes. While ALT and AST values less than 8 times normal may be seen in either hepatocellular or cholestatic liver disease values 25 times normal or higher are seen primarily in acute hepatocellular diseases. Patients with jaundice from cirrhosis can have normal or only slight elevations of the aminotransferases. Table 43-2 Hepatocellular Conditions that May Produce Jaundice Viral hepatitis Hepatitis A B C D and E Epstein-Barr virus Cytomegalovirus Herpes simplex Alcohol Drug toxicity Predictable dose-dependent . acetaminophen Unpredictable idosyncratic . isoniazid Environmental toxins Vinyl chloride Jamaica bush tea pyrrolizidine alkaloids Kava Kava Wild mushrooms Amanita phalloides or A. verna Wilson s disease Autoimmune .