e. Hypersensitivity cholestasis. Phenothiazines (especially chlorpromazine),
chlorpropamide, pheylbutazome, and sulfonamides may cause cholestatic jaundice and
"allergic" damage to biliary canaliculi and liver cells. Recovery is usual, but prolonged
jaundice and even death have been reported.
f. Steroid Cholestasis. If given in sufficient quantities, methyltestosterone,
norethandrolone, methandrostenolone, norethindrone, and other C-17 alkyl-substituted
steroids will eventually cause a mild reversible cholestasis with minimal changes in the
biliary canaliculi. Jaundice may be marked, but recovery is the rule.
4-18. ALCOHOLIC (ETHANOL) HEPATITIS
This form of hepatitis is seen exclusively in alcoholics and characterized by the
symptoms and signs of severe disruption of hepatic functions. It is a form of toxic
a. Causes. The pathogenesis is not established. Some of the patients are
obese. Males and females are affected about equally.
b. Pathology. The liver becomes large, firm, and often tender. There are fatty
changes, scattered areas of necrosis, an inflammatory reaction, disorganization of the
liver functions and stoppage of bile in the narrow passageways. In many sections, fine
strands of connective tissue extend into the lobules. Other sections may show clear-cut
signs of cirrhosis as well.
c. Signs and Symptoms. This illness appears suddenly with fever, jaundice,
ascites, and edema. In a short time, vascular "spiders" may appear. There may be a
bleeding phenomena. There is often an increased white blood count (WBC) and usually
anemia. Laboratory tests show severe disruption of liver functions.
d. Treatment. Treatment will include bed rest, abstaining from consumption of
alcohol, providing the required diet, and supportive measures as for cirrhosis. A
multivitamin preparation is usually given and should include folic acid.
e. Prognosis. A considerable number of patients die after a brief illness. Some
patients recover completely and others will progress to develop cirrhosis.