Although many different pathogenic agents and processes can affect
the liver (Table 14–1), they are
generally manifested in individual patients in a limited number
of ways that can be assessed by evaluation of some key parameters.
Liver disease can be acute or chronic, focal or diffuse, mild or
severe, and reversible or irreversible. Most cases of acute
liver disease (eg, caused by viral hepatitis) are so mild
that they never come to medical attention. Transient symptoms of
fatigue, loss of appetite, and nausea are often ascribed to other
causes (eg, flu), and minor biochemical abnormalities referable
to the liver that would be identified in blood studies are not discovered. The
patient recovers without any lasting medical consequences. In other
cases of acute liver injury, symptoms and signs are severe enough
to call for medical attention. The entire range of liver functions
may be affected or only a few, as is the case with liver injury
resulting from certain drugs that cause isolated impairment of the
liver’s role in bile formation (cholestasis). Occasionally,
viral and other causes of acute liver injury occur in an overwhelming
manner, resulting in massive liver cell death. This syndrome of fulminant
hepatic failure carries a high mortality rate; however, if
the patient survives, liver function returns to normal and there
is no residual evidence of liver disease.
Table 14–1 Categories of Liver Disease by Presentation. |Favorite Table|Download (.pdf)
Table 14–1 Categories of Liver Disease by Presentation.
|Reactions to certain classes of drugs (including
anabolic steroids, oral contraceptives, phenothiazines, erythromycins,
oral hypoglycemic and antithyroid drugs)||Viral hepatitis (types B, C, and D)|
|Primary autoimmune disorders (idiopathic autoimmune
chronic hepatitis, primary biliary cirrhosis, and sclerosing cholangitis)|
|Direct causes (intrahepatic biliary atresia,
cholangiocarcinoma, viral hepatitis, alcoholic hepatitis, primary
biliary cirrhosis, pericholangitis)|
|Therapeutic drug–induced (methyldopa,
nitrofurantoin, oxyphenisatin-containing laxatives)|
|Secondary causes (postoperative, endotoxins,
total parenteral nutrition, sickle cell crisis, hypophysectomy,
|Genetic diseases (Wilson’s disease, α1-antiprotease
|Acute hepatitis||Infiltrative disorders (sarcoidosis, amyloidosis, hemochromatosis)|
|Viral and bacterial, including hepatitis viruses
A, B, C, D, and E, herpes simplex virus, cytomegalovirus, Epstein-Barr
virus, yellow fever virus, brucella, leptospira||Cirrhosis|
|Infectious (viral hepatitis types B, C, and D and toxoplasmosis)|
|Reactions to certain classes of drugs (anesthetics
such as halothane, anticonvulsants such as phenytoin, antihypertensives
such as methyldopa, chemotherapeutic agents such as isoniazid, and
thiazide diuretics such as hydrochlorothiazide)||Genetic diseases (Wilson’s disease, hemochromatosis, α1-antiprotease
deficiency, glycogen storage diseases, Fanconi’s syndrome,
|Drugs and poisons (eg, methotrexate, alcohol)|
|Poisons (such as ethanol); reactions to drugs|
|Miscellaneous (sarcoidosis, graft-versus-host
disease, inflammatory bowel disease, cystic fibrosis, jejunoileal
bypass, diabetes mellitus)|
|Fulminant hepatic failure|
|Infections (with hepatitis viruses A, B, and
D, yellow fever virus, cytomegalovirus; herpes simplex virus, and Coxiella
burnetii)||Focal or extrinsic diseases with variable manifestations
in the liver|
|Vascular (hepatic vein thrombosis, occlusion
by parasites such as echinococcus or schistosoma)|
|Poisons and ...|
Log In to View More
If you don't have a subscription, please view our individual subscription options below to find out how you can gain access to this content.
Want remote access to your institution's subscription?
Sign in to your MyAccess profile while you are actively authenticated on this site via your institution (you will be able to verify this by looking at the top right corner of the screen - if you see your institution's name, you are authenticated). Once logged in to your MyAccess profile, you will be able to access your institution's subscription for 90 days from any location. You must be logged in while authenticated at least once every 90 days to maintain this remote access.
If your institution subscribes to this resource, and you don't have a MyAccess profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus.
AccessPhysiotherapy Full Site: One-Year Subscription
Connect to the full suite of AccessPhysiotherapy content and resources including interactive NPTE review, more than 500 videos, Anatomy & Physiology Revealed, 20+ leading textbooks, and more.
Pay Per View: Timed Access to all of AccessPhysiotherapy
24 Hour Subscription $34.95
48 Hour Subscription $54.95
Pop-up div Successfully Displayed
This div only appears when the trigger link is hovered over.
Otherwise it is hidden from view.