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Infectious disease
Published in Kaji Sritharan, Jonathan Rohrer, Alexandra C Rankin, Sachi Sivananthan, Essential Notes for Medical and Surgical Finals, 2021
Kaji Sritharan, Jonathan Rohrer, Alexandra C Rankin, Sachi Sivananthan
Some viruses commonly cause acute hepatitis and others chronic hepatitis: Acute hepatitis: clinical features: non-specific malaise with nausea, vomiting, fever, abdominal pain and jaundice.Chronic hepatitis: chronic infection with a hepatitis virus may be asymptomatic, or result in chronic hepatitis which may progress to cirrhosis with features of chronic liver disease and hepatocellular carcinoma.
Liver Diseases
Published in George Feuer, Felix A. de la Iglesia, Molecular Biochemistry of Human Disease, 2020
George Feuer, Felix A. de la Iglesia
Acute liver disease is usually related to bacterial or viral infection, or it is caused by drugs and other chemicals.37 The most important forms of acute hepatitis are viral, alcoholic, and drug-induced. The most common form is the acute infectious hepatitis caused by viruses.406,577 A differential diagnosis can be made between these disease forms by means of light microscopy, and liver injury details can be obtained by electronmicroscopy. A case of hepatitis is seen in Plate 2. Ultrastructural studies show that hepatic insufficiency can occur because of the endoplasmic reticulum injury in viral hepatitis and mitochondrial damage in alcoholic liver disease. In drug-induced hepatitis, mitochondrial damage can be noted in some cases (halothane)125 and endoplasmic reticulum injury in others (methyldopa).124,126 The mitochondrial damage involves both the inner and outer membranes, but not enlargement or crystalloid formation. Clinical manifestations may be the same irrespective of the target organelle. The compensatory and regenerative aspects of the disease process can be evaluated from the status of the endoplasmic reticulum membranes and ribosomes, and mitochondria.
The liver, gallbladder and pancreas
Published in C. Simon Herrington, Muir's Textbook of Pathology, 2020
Dina G. Tiniakos, Alastair D. Burt
Most clinically significant forms of viral hepatitis are caused by a disparate group of viruses known as hepatitis viruses (A, B, C, D, and E). In addition, a number of other viruses including Epstein–Barr virus, cytomegalovirus, rubella, and arboviruses (causing yellow fever) may at times be responsible for liver dysfunction. By convention, hepatitis is used to refer to diffuse liver injury, although the severity of the injury may be heterogeneous within the liver. The clinical presentation is variable. Acute hepatitis A and E infection often presents with general malaise, anorexia, and sometimes abdominal discomfort and liver tenderness. Only after this does the patient develop jaundice; thereafter recovery tends to occur. Sometimes presentation is with florid, overwhelming liver failure. Other forms of viral hepatitis may present similarly with an acute hepatitis but more often the onset may be insidious with presentation only after evidence of chronic disease is present.
Autophagy up-regulated by MEK/ERK promotes the repair of DNA damage caused by aflatoxin B1
Published in Toxicology Mechanisms and Methods, 2022
Weiya Cao, Jiafeng Gao, Yinci Zhang, Amin Li, Pan Yu, Niandie Cao, Jiaojiao Liang, Xiaolong Tang
AFB1, one of the most effective natural mutagens (Degola et al. 2017), is produced by Aspergillus flavus and Aspergillus parasiticus and easily pollutes many crops, especially corn and peanuts (Wang, Chen et al. 2016). AFB1 is absorbed in the gastrointestinal tract and bio-transformed through the cytochrome P450 (CYP450) in liver to generate the highly reactive epoxide intermediate AFB1-8,9-epoxide (AFBO) (Wang et al. 2019), causing oxidative stress and mutagenesis (Letouze et al. 2017). More than 60% of AFB1-related HCC carry p53 codon 249 mutations (Smela et al. 2002), inducing DNA damage and increasing the risk of HCC. Exposure to AFB1 causes irreversible liver damage. Acute hepatitis lasts less than six months but may progress to chronic hepatitis with repeated insults or unresolved injury. Chronic hepatitis causes liver fibrosis and liver cirrhosis, which cause more than 1 million deaths worldwide every year (Wedemeyer et al. 2015). Therefore, the damage caused by acute liver injury still cannot be ignored.
Elevated aspartate aminotransferase and alanine aminotransferase in the torsion of ovarian mature cystic teratoma: normalised after operation for torsion
Published in Journal of Obstetrics and Gynaecology, 2021
Jeong Namkung, Jung Hyun Park, Ji Hae Byun, Mee-Ran Kim
In the case of patient 2, since her preoperative AST/ALT level was too high, she had a consultation with a hepatobiliary specialist and anaesthesiologist before going into surgery. She was the only patient whose surgery was delayed, for the patient required further evaluation of liver function. A liver ultrasonography was performed and showed that the patient had suspected acute hepatitis. However, all hepatitis tests were negative and she had no specific past medical history or history of alcohol ingestion. The anaesthesiologist was given consent from the patient for the possibility of intensive care for severe liver failure and mortality rate. We performed a laparotomy 8 hours after the patient arrived at the hospital and we confirmed bilateral MCT with torsion of the right adnexa. Surgery consisted of detorsion and cystectomy, but the right ovary could hardly be saved because of severe necrosis. After surgery, the patient was admitted to an ICU. She was the only patient to receive hepatotonics. AST/ALT levels decreased to 118/606 immediately after surgery. She was transferred to the general ward on the day after the surgery. AST/ALT levels decreased to 67/374 on the second postoperative day and were normalised on the 23rd postoperative day. The patient followed up annually for five years and her liver function tests maintained in the normal range. Ultrasonography revealed that only a small amount of her ovarian tissue remained. Fortunately, however, her period showed about 35 days of regularity.
Hepatitis E should be a global public health priority: recommendations for improving surveillance and prevention
Published in Expert Review of Vaccines, 2020
Carl D Kirkwood, Katherine R Dobscha, A Duncan Steele
There is no specific treatment for hepatitis E. Patients with the uncomplicated infection do not require definitive treatment, with mild cases typically managed through rest and dietary modification. When acute hepatitis leads to fulminant hepatic failure, patients require supportive intensive care and early transplant if available, but the median time between the onset of ALF and death, transplant, or recovery is less than a week [64]. The use of antivirals (ribavirin and alpha-interferon) has been limited to treating chronic HEV3 infections in transplant patients. Recent studies have found some potential drug candidates with antiviral activity against HEV1 in vitro [64,65], however, there is insufficient evidence to support antiviral use for HEV-induced acute hepatitis. Antiviral therapy can be challenging in resource-poor settings due to a lack of generic options and or access to care [66]. Both interferon and ribavirin are also contraindicated during pregnancy, limiting their potential utility for the highest-need populations [64].