Health Human Disease Blog

Hepatic granulomas are common, being found in 2 to 10 per cent of all liver biopsies, often in association with an elevated serum alkaline phos­phatase level. However, they are rarely a specific finding and have been reported in association with a wide variety of infections, systemic ill­nesses, hepatobiliary disorders, drugs, and toxins, some of which are listed in. Although granulomas are a nonspecific finding, occasion­ally specific features are seen, such as acidfast bacilli in tuberculosis, ova in schistosomiasis, lar­vae in toxocariasis, and birefringent granules in starch, talc, or silicone granulomas. The differ­ential diagnosis of hepatic granulomas is one of the most extensive in medicine, and the workup requires meticulous attention to details of the his­tory, physical examination, and laboratory tests. Indeed, in 20 per cent or more of patients, no cause for granulomas is found despite extensive investigation. A subset of these patients, who have a syndrome consisting of fever, hepatome­galy, and hepatic granulomas which responds to administration of corticosteroids, has been de­scribed as having granulomatous hepatitis, al­though some feel that these individuals have a variant of sarcoidosis.

Conversely, liver biopsy (and culture, particu­larly of acidfast bacteria) is of considerable value in the diagnosis of sarcoidosis, miliary tuberculosis, and histoplasmosis, as virtually all patients with these disorders will have hepatic granu­lomas. Similarly, characteristic granulomas are seen in many patients with primary biliary cir­rhosis, and granulomas may be the first clue to Hodgkin’s disease.

• Improving Case Management
• LIVER ABSCESS
• Endocrine Systems
• CLINICAL MANIFESTATIONS OF ENDSTAGE RENAL DISEASE
• Conjugated Hyperbilirubinemia
• THE COMMON CLINICAL MANIFESTATIONS OF GASTROINTESTINAL DISEASE
• GENERAL SURGERY IN THE PATIENT WITH HEART DISEASE
• Hematuria
• Studies of Pancreatic Structure and Function
• Women’s Health Program
• PATHOPHYSIOLOGY OF AIRWAY OBSTRUCTION
• Screening and Prevention
• MYOCARDIAL METABOLISM
• Therapy
• CARCINOMA OF THE PANCREAS - Clinical Manifestations
• Direct (Toxic Nephropathy)
• Polycystic Kidney Disease (PKD)
• Renal Tubular Acidosis
• Blood Chemistries
• CYSTIC FIBROSIS
• Liddle’s Syndrome
• THE FAMILIAL POLYPOSIS SYNDROMES
• Other Clearly Extrinsic Causes of Diffuse Infiltrative Lung Disease
• DRUGS
• AORTIC ARTERITIS
• PHYSICAL EXAMINATION
• Renal Artery Occlusion
• EFFECTORS OF THE RESPIRATORY SYSTEM
• POLYPS OF THE GASTROINTESTINAL TRACT
• Bartter’s Syndrome
• Sickle Cell Anemia (SS)
• CLINICAL CLASSIFICATION OF JAUNDICE
• Genitourinary System
• CLINICAL APPROACH TO LIVER DISEASE
• PHYSIOLOGY OF THE PULMONARY CIRCULATION