Table 18-4: Patterns of Drug- and Toxin-Induced Hepatic Injury Flashcards
1
Q
Pattern of injury: Cholestatic
Morphological findings? Examples of Associated Agents?
A
- Bland hepatocellular cholestasis, without inflammation
- Contraceptive and anabolic steroids, antibiotics, HAART
2
Q
Cholestatic hepatitis
Morphological findings? Examples of Associated Agents?
A
- Chlolestasis with lobular necroinflammatory activity; may show bile duct destruction
- Ex: Antibiotics, phenothiazines, statins
3
Q
Hepatocellular necrosis
Morphological findings? Examples of Associated Agents?
A
- Spotty hepatocyte necrosis: methyldopa, phenytoin
- Massive necrosis: acetaminophen, halothane
- Chronic hepatitis: isoniazid
4
Q
Fatty liver disease
Morphological findings? Examples of Associated Agents?
A
- Large and small droplet fat: ethanol, corticosteroids, methotrexate, total parenteral nutrition
- “Microvesicular steatosis” (diffuse small droplet fat): Valproate, tetracycline, aspirin (Reye syndrome), HAART
- Steatohepatitis with Mallory-Denk bodies–Ethanol, amiodarone
5
Q
Fibrosis and cirrhosis
Morphological findings? Examples of Associated Agents?
A
- Periportal and pericellular fibrosis
- Alcohol, methotrexate, enalapril, vitamin A, and other retinoids
6
Q
Granulomas
Morphological findings? Examples of Associated Agents?
A
- Noncaseating epithelioid granulomas: sulfonamides, amiodarone, isoniazid
- Fibrin ring granulomas: Allopurinol
7
Q
Vascular lesions
Morphological findings? Examples of Associated Agents?
A
- SOS (vena-occlusive disease): obliteration of central veins–high dose chemotherapy, bush teas
- Bud Chiari syndrome: Oral contraceptives
- Peliosis hepatitis: blood-filled cavities, not lined by endothelial cells: Anabolic steroids, tamoxifen
8
Q
Neoplasms
Morphological findings? Examples of Associated Agents?
A
- Hepatocellular adenoma: oral contraceptives, anabolic steroids
- HCC: Alcohol, Thorotrast
- CCA: Thorotrast
- Angiosarcoma: Thorotrast, vinyl chloride
