Drug Induced Liver Failure (Marino/Gupta)

Question 1

What changes do you expect to see in acute liver failure due to drugs?
• Gross
• Histo

Answer 1

Gross:
• Small, Bile stained, soft, and congested

Histo:
• Necrosis around central vein in zone 3. Hepatocytes near portal triad remain viable.

Question 2

What kinds of inflammatory cells will you see on drug induced hepatitis?

Answer 2

Hepatitis, neutrophilic, lymphocytic, eosinophilic, granulomatous or any combination of those, can be due to drugs.​

Question 3

Seen here is PERIPORTAL LYMPHOCYTIC infiltration due to isoniazid.

Answer 3

Hepatitis (Granulomatous?)

Question 4

Drug induced hepatitis with lymphocytic infiltration

Question 5

Answer 5

Question 6

Answer 6

Question 7

Answer 7

Question 8

What are key features of Liver Tissue that has undergone changes from amiodarone exposure?
• what causes this effect?

Answer 8

Amiodarone can cause steatohepatitis, Mallory-Denk bodies or granulomas, but its most distinctive hepatotoxicity is phospholipidosis. ​
Mechanism:
It binds to membrane phospholipids and messes up their​ recycling in lysosomes.

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Question 9

Describe what you see?
• what caused this?

Answer 9