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Non Viral Hepatitis - Causes, Symptoms and Treatment

What is Non Viral Hepatitis?

Classified as toxic or drug-induced (idiosyncratic) hepatitis, non viral hepatitis is an inflammation of the liver. Most patients recover from this illness, although a few develop fulminating hepatitis or cirrhosis.

What are the Causes of Non Viral Hepatitis?

Non viral hepatitis results from various causes:

1. Alcohol Overuse: may lead to inflammation of the liver; continued alcohol intake can have severe effects, such as cirrhosis and liver failure.

2. Direct Hepatotoxicity: hepatocellular damage and necrosis, usually caused by toxins. It is dose-dependent and primarily caused by acetaminophen overdose.

3. Idiosyncratic Hepatotoxicity: typically follows a sensitization period of several weeks; caused by hypersensitivity to medications (for example, isoniazid, methyldopa, mercaptopurine, lovastatin, pravastatin, dipyridamole, and halothane)

4. Cholestatic Reactions: lack of bile excretion; possibly direct hepatotoxicity from oral contraceptives or anabolic steroids; hypersensitivity to phenothiazine derivatives such as chlorpromazine, antibiotics, thyroid medications, anti diabetic drugs; and cytotoxic drugs

5. Metabolic and Autoimmune Disorders: acute exacerbations of sub clinical liver disease, such as autoimmune hepatitis and Wilson's disease

6. Infectious Agents: systemic viruses, such as cytomegalovirus, mononucleosis or Epstein-Barr virus, measles virus, varicella zoster, adenovirus, herpes simplex virus, coxsackievirus, and human immunodeficiency virus; spirochetes such as those that cause syphilis and leptospirosis.

Signs and Symptoms of Non Viral Hepatitis

Clinical features of toxic and drug-induced hepatitis vary with the severity of liver damage and the causative agent. In most patients, symptoms resemble those of viral hepatitis: anorexia, nausea, vomiting, jaundice, dark urine, hepatomegaly, possibly abdominal pain (with acute onset and massive necrosis), clay-colored stools, and, in the cholestatic form of hepatitis, pruritus.

Carbon tetrachloride poisoning also produces headache, dizziness, drowsiness, and vasomotor collapse; halothane-related hepatitis produces fever, moderate leukocytosis, and eosinophilia; chlorpromazine produces a rash, abrupt fever, arthralgias, lymphadenopathy, and epigastric or right-upper-quadrant pain.

Diagnosis for Non Viral Hepatitis

Diagnostic findings include elevations in serum aspartate aminotransferase, alanine aminotransferase, total and direct bilirubin (with cholestasis), and alkaline phosphatase levels; elevated white blood cell (WBC) count; and elevated eosinophil count (possible in the drug-induced type). A liver biopsy may help identify the underlying pathology, especially infiltration with WBC's and cosillophils. Liver function tests have limited value in distinguishing between non viral and viral hepatitis.

Treatment for Non Viral Hepatitis

Effective treatment must remove the causative agent by lavage, catharsis, or hyperventilation, depending on the route of exposure. Acetylcysteine may serve as an antidote for toxic hepatitis caused by acetaminophen poisoning but doesn't prevent drug-induced hepatitis caused by other substances.

Corticosteroids may be prescribed for patients with drug-induced hepatitis.

Prevention Tips for Non Viral Hepatitis

To prevent non-viral hepatitis, teach the patient the proper use of drugs and the proper handling of cleaning agents and solvents.

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