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Granuloma of the liver caused by many things and are generally asymptomatic. However, the underlying diseases extrahepatic manifestations, inflammation of the liver, fibrosis, portal hypertension, or a combination thereof may cause. Diagnosis is based on liver biopsy. but a liver biopsy is necessary only if a treatable cause (z. B. infection) is suspected or other diseases must be excluded. Treatment depends on the underlying disease.
Granuloma of the liver may be insignificant, but are usually an expression of clinically relevant disease. The term “granulomatous hepatitis” is often used to describe, but the disease is not a real hepatitis is and the presence of granulomas does not imply any inflammation of the liver parenchyma.
Granuloma of the liver caused by many things and are generally asymptomatic. However, the underlying diseases extrahepatic manifestations, inflammation of the liver, fibrosis, portal hypertension, or a combination thereof may cause. Diagnosis is based on liver biopsy. but a liver biopsy is necessary only if a treatable cause (z. B. infection) is suspected or other diseases must be excluded. Treatment depends on the underlying disease. Granuloma of the liver may be insignificant, but are usually an expression of clinically relevant disease. The term “granulomatous hepatitis” is often used to describe, but the disease is not a real hepatitis is and the presence of granulomas does not imply any inflammation of the liver parenchyma. Etiology granuloma of the liver have many causes (see Table: granuloma of the liver), drugs and systemic diseases (mostly infections) are more often the cause as primary liver disease. It is important that infections are diagnosed because they require a specific therapy usually. The tuberculosis and schistosomiasis provide the world’s most common infectious causes are, fungal and viral causes are less frequent. The Sarkoidoseist the most common non-infectious cause of liver involvement is present in up to two thirds of the patients and, occasionally, the klinsche manifestation of sarcoidosis is primarily hepatic. Granulomas the liver cause Examples drug allopurinol, phenylbutazone, quinidine, sulfonamides infections, bacterial actinomycosis, brucellosis, cat scratch disease fever, Syphilis, TB *, other mycobacteria, tularemia, Q fever infections, fungal blastomycosis, cryptococcosis, histoplasmosis infections, parasitic S chistosomiasis *, toxoplasmosis, visceral larva migrans infection, viral hepatitis C, cytomegalovirus infections liver disease Primary biliary cirrhosis Systemic diseases Hodgkin’s lymphoma, polymyalgia rheumatica, collagen diseases, sarcoidosis * * The most common causes. Granulomas are rare in primary liver disorders, the only significant cause is primary biliary cirrhosis. In other liver diseases occasionally small granulomas occur, but they have no clinical relevance. Idiopathic granulomatous hepatitis is a rare syndrome, often occur intermittently in the granulomas in the liver with recurrent fever, muscle aches, fatigue and other systemic symptoms for years. Some specialists consider them as a variant of sarcoidosis. A pathophysiology granuloma consists of a localized accumulation of chronic inflammatory cells with epithelioid cells and multinucleated giant cells. A caseating necrosis and foreign bodies (eg. As schistosome eggs) may be present. Most granulomas are found in the parenchyma, but with primary biliary cirrhosis granulomas are found in the portal fields. The granuloma is only partially understood pathophysiology. Granulomas may develop in response to poorly soluble, exogenous or endogenous irritants. Immunological mechanisms are involved. Granuloma of the liver rarely interfere with liver function. However, if granulomas are only one part of a larger inflammatory damage in the liver (eg. as drug reaction, infectious mononucleosis), a disorder of hepatocellular function occur. Sometimes the inflammation causes progressive liver fibrosis and portal hypertension. This picture is typical of a schistosomiasis and occurs in the framework of sarcoidosis even when pronounced infiltration. Symptoms and complaints The granulomas as such are typically asymptomatic. Even a strong infiltration caused only a slight hepatomegaly and no or poor levels of jaundice When symptoms occur, they are an expression of the underlying disease (eg. As constitutional symptoms in infections, hepatosplenomegaly in schistosomiasis). Diagnostic liver imaging techniques Biopsy Hepatic granulomas may be suspected in patients with disorders that usually cause granulomas Unexplained liver lesions, which is found in imaging studies anomalies that were detected by imaging methods that asymptomatic to investigate increases in liver enzymes, particularly alkaline phosphatase, be performed. On suspicion of granulomas usually the liver values ??are determined, although the results are usually not specific and only rarely helpful in diagnosis. Alkaline phosphatase (and gamma glutamyl transferase) are often only small, significantly increased in rare cases. Further tests may be normal or abnormal, and an additional liver damage point (such. As a diffuse inflammation in the liver tissue due to a reaction to a drug). Imaging techniques such as ultrasound, computed tomography or MRI does not usually lead to the diagnosis. They show calcification (if granulomas are made longer) or filling defects, v. a. in confluent lesions. The diagnosis is based on a liver biopsy. Nevertheless, the biopsy is usually only suspected treatable causes (eg. As infections) indexed and perimeter nichtgranulomatösen diseases (eg. As chronic viral hepatitis). The biopsy sometimes provides information on a specific cause (z. B. schistosome eggs, Caseation in tuberculosis, fungal organisms). However, further investigation is required (eg. as cultures, skin tests, laboratory tests, imaging and other tissue samples) are common. In patients with constitutional or other symptoms suggestive of infection (z. B. fever of unknown origin), specific procedures must be employed to increase the diagnostic sensitivity of a biopsy with regard to infectious causes (z. B. applying a culture of the organism from fresh biopsies or production of special stains for acid-fast bacteria, fungi and other organisms). But often the cause can not be identified. Lebergranulome prognosis, which are caused by drugs or infections, are formed completely after discontinuation of the medication or treatment. Granulomas in the context of sarcoidosis can disappear spontaneously or persist for years to create a rule without a clinically significant liver disease. Rarely results in a progressive fibrosis or portal hypertension (sarcoidosis-related cirrhosis). When schistosomiasis a progressive portal scarring (pipe-stem fibrosis) is typical. The liver function is usually obtained, but a marked splenomegaly and variceal bleeding may occur. Therapy treatment of the cause, the treatment depends on the underlying disease. If the cause is not known, no therapy is first introduced, but follow-up studies are carried out with regular liver function tests and sonography. However, if symptoms of tuberculosis (long-lasting fever, deterioration of general condition) occur, an empirical antituberculosis therapy is warranted. Patients with progressive hepatic sarcoidosis may benefit from treatment with corticosteroids, although it is not known whether these drugs can prevent liver fibrosis. Corticosteroids are not indicated for most patients with sarcoidosis and justified, tuberculosis or other infections can be safely ruled out. Important points cause of hepatic granulomas may be many drugs and systemic diseases; primary liver diseases are often the cause. Tuberculosis and schistosomiasis are the most common infectious causes worldwide. Sarcoidosis is the most common non-infectious cause. Symptoms and complications resulting mainly from the underlying disease, fewer of the granuloma itself. The treatment depends on the particular cause.