Li-8-3 TOXIC LIVER INJURY By Dr. Orfei
The list of these agents is interminable and is continually increasing as new chemical products are synthesized. They range from A to Z (from Acetone to Xylene).
MORPHOLOGICAL FORMS OF INJURY
Toxic agents may produce a variety of morphological changes which may be typical of various agents. Usually changes induced by toxins are accompanied by little or no inflammatory reaction. The changes may be acute or chronic.
Acute changes will affect hepatocytes with necrosis, degeneration, steatosis. They will affect bile flow with cholestasis at various levels and will affect the vascular structures
Chronic changes will manifest as chronic hepatitis with various forms of necrosis: focal , confluent, submassive, massive and granulomas. There may be fibrosis and cirrhosis. Some toxins will affect bile ducts and some blood vessels with sclerotic occlusive lesions and peliosis. Some other compounds seem to influence the growth of neoplasms.
Each compound causes different lesions, therefore the references on the toxicity of each chemical should be consulted in each occurrence. Their listing and discussion are beyond the scope of these pages.
Toxic etiology should be included in the differential diagnosis of every liver ailment.
Some common hepatotoxics and their damage.
Aflatoxin B from moldy foods, rice, corn, cassava, oil. It causes jaundice , fatty liver, Reye= syndrome, hepatocellular carcinoma, thromboses , phlebitis, phlebosclerosis and veno-occlusive disease.
Amanita phalloides, mushroom poisoning, causes centrolobular and massive necrosis.
Benzene from chemical industry, shoe fabrication. It causes steatosis and cirrhosis.
Beryllium from X-ray tube and fluorescent lamp manufacture. It causes necrosis and granulomas.
Boron, cadmium from gold melting, nickel, chromium from plating, copper sulphate.
Carbon tetrachloride: Centrolobular necrosis
Cooking oil from adulterated rapeseed from Spain 1981.
Kerosene from fuel handling.
Lead: nuclear inclusions, steatosis, hepatitis.
Pesticides: Steatosis, angiosarcoma.
Phosphorus from poisons and fire crackers. Fatty liver, necrosis, fibrosis.
Pyrrolizidine alkaloids: veno-occlusive disease. From bush tea with senecio, cereals with crotolaria.
Toluene, xylene: Fatty liver, fibrosis.
Vinyl chloride: Angiosarcoma, fibrosis,