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{{Peliosis hepatis}}
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==[[Peliosis hepatis overview|Overview]]==


==[[Peliosis hepatis historical perspective|Historical Perspective]]==


==Overview==
==[[Peliosis hepatis classification|Classification]]==
'''Peliosis Hepatis''' is an uncommon [[Blood vessel|vascular]] condition characterised by randomly distributed multiple blood-filled cavities throughout [[liver]]. Size of the cavities usually ranges between a few millimetres to 3 cm in diameter<ref name="marvin">{{cite book | last = Sleisenger | first = Marvin | title = Sleisenger and Fordtran's Gastrointestinal and Liver Disease | publisher = W.B. Saunders Company | location = Philadelphia | year = 2006 |isbn = 1416002456 }} Chapter 80  </ref>. In the past it was a mere [[histological]] curiosity  occasionally found at [[autopsies]] but has been increasingly recognised with wide ranging conditions from [[AIDS]] to the use of [[anabolic steroid]]s. It also occasionally affects [[spleen]], [[lymph nodes]], [[lungs]], [[kidneys]], [[adrenal glands]], [[bone marrow]] and other parts of [[gastrointestinal tract]].<ref>{{cite journal |author=Ichijima K, Kobashi Y, Yamabe H, Fujii Y, Inoue Y |title=Peliosis hepatis. An unusual case involving multiple organs |journal=Acta Pathol. Jpn. |volume=30 |issue=1 |pages=109-20 |year=1980 |pmid=7361545}}</ref>. 


Peliosis hepatis is often erroneously written "peliosis hepati''ti''s", despite its not being one of the [[hepatitis|hepatitides]].  The correct term arises from the Greek ''pelios'', i.e. discoloured by extravasated blood, livid<ref>{{cite web |url=http://www.perseus.tufts.edu/cgi-bin/ptext?doc=Perseus%3Atext%3A1999.04.0057%3Aentry%3D%2380479 |title=Henry George Liddell, Robert Scott, A Greek-English Lexicon |accessdate=2007-06-11 |format= |work=}}</ref>, and the Latinized Genitive case (hepatis<ref>{{cite web |url=http://www.perseus.tufts.edu/cgi-bin/ptext?doc=Perseus%3Atext%3A1999.04.0059%3Aentry%3D%2320439 |title=Charlton T. Lewis, Charles Short, A Latin Dictionary |accessdate=2007-07-02 |format= |work=}}</ref>) of the Greek ''hepar'', liver<ref>{{cite web |url=http://www.perseus.tufts.edu/cgi-bin/ptext?doc=Perseus%3Atext%3A1999.04.0057%3Aentry%3D%2347443 |title=Henry George Liddell, Robert Scott, A Greek-English Lexicon |accessdate=2007-07-02 |format= |work=}}</ref>.
==[[Peliosis hepatis pathophysiology|Pathophysiology]]==


== Pathophysiology ==
==[[Peliosis hepatis causes|Causes]]==
The [[pathogenesis]] of peliosis hepatis is unknown. There are several [[Hypothesis|hypotheses]], such as, it arise from [[sinusoidal]] epithelial damage<ref>{{cite journal |author=Gushiken FC |title=Peliosis hepatis after treatment with 2-chloro-3'-deoxyadenosine |journal=South. Med. J. |volume=93 |issue=6 |pages=625-6 |year=2000 |pmid=10881786}}</ref>, increased sinusoidal pressure due to obstruction in blood outflow from the liver, or hepatocellular [[necrosis]]<ref name="marvin"/>.


Two [[morphology (biology)|morphologic]] patterns of hepatic peliosis were described by Yanoff and Rawson <ref>{{cite journal |author=YANOFF M, RAWSON AJ |title=PELIOSIS HEPATIS. AN ANATOMIC STUDY WITH DEMONSTRATION OF TWO VARIETIES |journal=Archives of pathology |volume=77 |issue= |pages=159-65 |year=1964 |pmid=14088761}}</ref>. In the '''phlebectatic''' type, the blood-filled spaces are lined with [[endothelium]] and are associated with [[aneurysm|aneurism]]al dilatation of the central vein; in the '''parenchymal''' type, the spaces have no endothelial lining and they usually are associated with [[haemorrhagic]] [[parenchyma]]l [[necrosis]]. Some considers both pattern to be one process, initiated by focal [[necrosis]] of liver parenchyma observed in parenchymal type progressing into formation of [[fibrous]] wall and endothelial lining around [[haemorrhage]] of phebectatic type. [[Fibrosis]], [[cirrhosis]], regenerative nodules, and [[tumor|tumours]] may also be seen.
==[[Peliosis hepatis differential diagnosis|Differentiating Peliosis hepatis from Other Diseases]]==


===Causes===
==[[Peliosis hepatis epidemiology and demographics|Epidemiology and Demographics]]==


===Drug Causes===
==[[Peliosis hepatis risk factors|Risk Factors]]==  


* [[Fluoxymesterone]]
==[[Peliosis hepatis screening|Screening]]==
* [[Oxandrolone]]
* [[Nandrolone]]
* [[oxymetholone]]


== Disease associations ==
==[[Peliosis hepatis natural history, complications and prognosis|Natural History, Complications, and Prognosis]]==
*'''Infections:''' [[HIV]], Bacillary peliosis (caused by genus  ''[[Bartonella]]'', bacteria responsible for [[cat-scratch disease]] which are identified histologically adjacent to the peliotic lesions<ref>{{cite journal |author=Koehler JE, Sanchez MA, Garrido CS, Whitfeld MJ, Chen FM, Berger TG, Rodriguez-Barradas MC, LeBoit PE, Tappero JW |title=Molecular epidemiology of bartonella infections in patients with bacillary angiomatosis-peliosis |journal=N. Engl. J. Med. |volume=337 |issue=26 |pages=1876-83 |year=1997 |pmid=9407154}}</ref>), ''[[Staphylococcus aureus]]''<ref>{{cite journal |author=Perkocha LA, Geaghan SM, Yen TS, Nishimura SL, Chan SP, Garcia-Kennedy R, Honda G, Stoloff AC, Klein HZ, Goldman RL |title=Clinical and pathological features of bacillary peliosis hepatis in association with human immunodeficiency virus infection |journal=N. Engl. J. Med. |volume=323 |issue=23 |pages=1581-6 |year=1990 |pmid=2233946}}</ref>
*'''Chronic conditions:'''  End stage [[renal failure]], [[Kwashiorkor]], [[tuberculosis]] and other chronic infections.
*'''Malignancy:''' [[Monoclonal gammopathy|Monoclonal gammopathies]] ([[multiple myeloma]] and [[Waldenstrom macroglobulinemia]]), [[Hodgkin's disease]], [[malignant histiocytosis]], [[seminoma]], [[hepatocellular adenoma]] and [[Hepatocellular carcinoma|hepatocarcinoma]],<ref>{{cite journal |author=Haboubi NY, Ali HH, Whitwell HL, Ackrill P |title=Role of endothelial cell injury in the spectrum of azathioprine-induced liver disease after renal transplant: light microscopy and ultrastructural observations |journal=Am. J. Gastroenterol. |volume=83 |issue=3 |pages=256-61 |year=1988 |pmid=3278593}}</ref>
* '''Renal transplants:'''  It can be found in up to 20% patients, can be related to azathioprine or cyclosporine use and may be associated with increased risk of [[transplant rejection]]<ref>{{cite journal |author=Izumi S, Nishiuchi M, Kameda Y, Nagano S, Fukunishi T, Kohro T, Shinji Y |title=Laparoscopic study of peliosis hepatis and nodular transformation of the liver before and after renal transplantation: natural history and aetiology in follow-up cases |journal=J. Hepatol. |volume=20 |issue=1 |pages=129-37 |year=1994 |pmid=8201214}}</ref><ref>{{cite journal |author=Cavalcanti R, Pol S, Carnot F, Campos H, Degott C, Driss F, Legendre C, Kreis H |title=Impact and evolution of peliosis hepatis in renal transplant recipients |journal=Transplantation |volume=58 |issue=3 |pages=315-6 |year=1994 |pmid=8053054}}</ref>.
*'''Drugs and toxins:''' [[Corticosteroids]], [[androgens]], [[methyltestosterone]], [[azathioprine]], [[tamoxifen]]<ref>{{cite book | last = Goldman | first = Lee | title = Cecil Textbook of Medicine -- 2-Volume Set, Text with Continually Updated Online Reference | publisher = W.B. Saunders Company | location = Philadelphia | year = 2003 | isbn = 0721645631 }}</ref>


== Clinical features ==
==Diagnosis==
The condition is typically asymptomatic and is discovered following evaluation of abnormal [[liver function test]]. However, when severe it can manifest as [[jaundice]], [[hepatomegaly]], [[liver failure]] and [[Hemoperitoneum|haemoperitoneum]].
[[Peliosis hepatis history and symptoms|History and Symptoms]] | [[Peliosis hepatis physical examination|Physical Examination]] | [[Peliosis hepatis laboratory findings|Laboratory Findings]] | [[Peliosis hepatis electrocardiogram|Electrocardiogram]] |[[Peliosis hepatis chest x ray|Chest X Ray]] | [[Peliosis hepatis CT|CT]] | [[Peliosis hepatis MRI|MRI]] |  | [[Peliosis hepatis other imaging findings|Other Imaging Findings]] | [[Peliosis hepatis other diagnostic studies|Other Diagnostic Studies]]


== Treatment ==
==Treatment==
=== Antimicrobial regimen ===
[[Peliosis hepatis medical therapy|Medical Therapy]] | [[Peliosis hepatis surgery|Surgery]] | [[Peliosis hepatis primary prevention|Primary Prevention]] | [[Peliosis hepatis secondary prevention|Secondary Prevention]] | [[Peliosis hepatis cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Peliosis hepatis future or investigational therapies|Future or Investigational Therapies]]
* Bacillary peliosis hepatitis (peliosis hepatis caused by ''Bartonella spp.'')<ref> {{cite book | last = Gilbert | first = David | title = The Sanford guide to antimicrobial therapy | publisher = Antimicrobial Therapy | location = Sperryville, Va | year = 2015 | isbn = 978-1930808843 }}</ref>


:*Preferred regimen (1): [[Clarithromycin]] 500 mg bid for 4 months
==Case Studies==
:*Preferred regimen (6): [[Erythromycin]] 500 mg PO qid for 4 months
[[Peliosis hepatis case study one|Case #1]]
:*Preferred regimen (2): [[Doxycycline]] 100 mg PO bid for 4 months
*Special Consideration
:*Severe disease
::* Preferred regimen: [[Doxycycline]] 100 mg PO/IV bid for 4 months {{and}} [[Rifampin]] 300 mg PO bid for 4 months


== Other cystic conditions of liver ==
*[[Polycystic Liver Disease]]
*Solitary congenital cysts
*[[Congenital hepatic fibrosis]]
*[[Hydatid cyst]]
*Von Meyenburg complexes
*[[Caroli disease]] (type V choledochal cyst)
*Type IV [[choledochal cysts]]


== References ==
{{Reflist|2}}
{{Gastroenterology }}
{{Cystic diseases}}
[[Category:Gastroenterology]]
[[Category:Pathology]]
[[Category:Needs patient information]]
[[Category:Mature chapter]]
[[Category:Hepatology]]
[[Category:Hepatology]]


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Revision as of 16:17, 2 June 2016

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Template:Your Name

Overview

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Causes

Differentiating Peliosis hepatis from Other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications, and Prognosis

Diagnosis

History and Symptoms | Physical Examination | Laboratory Findings | Electrocardiogram |Chest X Ray | CT | MRI | | Other Imaging Findings | Other Diagnostic Studies

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