Non-viral liver infection Flashcards
How does extrahepatic infection cause hepatocellular cholestasis?
Pro-inflammatory cytokines released by Kupffer cells and endothelial cells in response to endotoxins
What are three examples of bacteria that can infect the liver directly?
Staphylococcus aureus (toxic shock syndrome)
Salmonella typhi (typhoid fever)
T. pallidum (secondary or tertiary syphilis)
What does cholestasis make the liver prone to in terms of bacterial infection?
Bacterial proliferation in the biliary tree
What are the two main causes of cholangitis?
Biliary tract manipulation
Common bile duct stones
(less common include tumours and strictures)
What bacteria can cause ascending cholangitis?
Gut bacteria
E. coli, Klebsiella, Enteroccocus species
Bacteroides fragilis in main anaerobic organism
T/F helminthic and parasitic hepatic infections are not important globally
False
Major causes of morbidity worldwide
What are important helminthic/parasitic infections?
Malaria
Schistosomiasis
Strongyloidiasis
Cryptosporidiosis
Fasciola hepatica and Clonorchis sinensis (liver flukes)
How is the liver involved in malarial infections?
Lysis of RBCs can cause jaundice
P vivax and P ovale may produce dormant form that persists in the liver
How is the liver involved in strongyloidiasis?
In the autoinfectious stages (latest, and most dangerous), reached only in immunocompromised patients, liver can be infected
How is the liver involved in cryptosporidiosis?
In AIDS patients with very low CD4 T cell counts
Biliary involvement including sclerosing cholangitis, papillary stenosis
What are ways that bacteria can enter the liver?
Biliary tree infection from gut bacteria leading to spread to liver parenchyma
Portal vein pyraemia from appendicitis, peritonitis and pancreatitis)
Septicaemia through hepatic artery (bacterial endocarditis, pneumonia, IV drug use)
Complicated liver trauma from blunt or penetrative injury
What is Charcot’s triad, in the context of liver infections?
Triad of symptoms in bacterial ascending cholangitis
Fever, upper right abdominal pain, jaundice
What is Reynold’s pentat in the context of liver infections?
5 symptoms of serious ascending cholangitis
Extends Charcot’s tried of fever, upper right abdominal pain and jaundice with shock and altered mental state (confusion)
