DIAGNOSIS
■ Elevated LFTS, bilirubin, and serum gamma-globulins
■ ANA and anti–smooth muscle antibody+
DIFFERENTIAL
■ Viral hepatitis
■ Primary biliary cirrhosis
TREATMENT
■ Supportive care acutely
■ Prednisone ± azathioprine
Cirrhosis
Cirrhosis is the final common pathway of many liver diseases that cause hepa-
tocellular injury, and →fibrosis and nodular regeneration. Reversal may
occur with treatment of some chronic liver diseases (eg, HBV, HCV).
SYMPTOMS
■ Fatigue, anorexia, muscle wasting, loss of libido, impotence, dysmenorrhea
■ Decompensation associated with GI bleeding, encephalopathy (sleep-wake
reversal,↓concentration), ascites
■ Platypnea(dyspnea induced by sitting upright and relieved by recum-
bency) and orthodeoxia(low PaO 2 when sitting upright that is relieved by
recumbency)
EXAM
■ Stigmata of chronic liver disease: Palmar erythema spider telangiectasia
■ Dupuytren contractures, gynecomastia, testicular atrophy, bilateral parotid
enlargement, Terry nails (white, obscure nails)
ABDOMINAL AND GASTROINTESTINALEMERGENCIESTABLE 11.13. Toxins Causing Liver Injury
Toxic Toxic and Idiosyncratic
Alcohol Methyldopa
Acetaminophen Isoniazid
Salicylates Sodium valproate
Tetracyclines Amiodarone
Trichloroethylene Primarily cholestatic
Vinyl chloride Chlorpromazine
Carbon tetrachloride Cyclosporine
Yellow phosphorus Oral contraceptives
Poisonous mushrooms (Amanita, Galerina) Anabolic steroids
Idiosyncratic Erythromycin estolate
Volatile anesthetics (halothane) Methimazole
Phenytoin
Sulfonamides
Rifampin
Indomethacin