acute lobular hepatitis
acute lobular hepatitisLiver inflammation of abrupt onset, which is characterised by patchy confluent pan- and multi-acinar necrosis, with loss of hepatocytes and marked ductular reaction around portal tracts. Acute lobular hepatitis with lesser degrees of necrosis and some regeneration forms nodules and mimics cirrhosis.
Low-grade fever, anorexia, nausea, vomiting, fatigue, malaise, headache, photophobia, pharyngitis, cough; later, dark urine, light stool, jaundice, hepatomegaly, ±splenomegaly, ±lymphadenopathy.
Autoimmune, drugs, toxins, viral.
Decreased ALT falsely suggests liver improvement; raised prothrombin signals liver failure and need for tertiary (liver centre) referral.
Liver biopsy; increased transaminases (ALT, AST); increased virus-specific IgG or IgM.