Other Etiologies

Viral agents

There is accumulating evidence that there are other hepatitis viruses, based on the observation that known viruses do not account for all cases of hepatitis.The newly discovered hepatitis F and G viruses are believed to be transmitted via infected blood. Recent scientific studies indicate the existence of other, as yet unidentified, viral agents that cause hepatitis.

Hepatotoxins

Excluding alcohol, the drugs and herbal remedies that can produce hepatic injury are too numerous to list.

• Alcohol-related: fatty liver disease, acute alcoholic hepatitis, or alcoholic cirrhosis
• Drugs and toxins
  • Dose dependent reaction may be caused by acetaminophen (Tylenol), carbon tetrachloride, and methotrexate. The effect of acetaminophen and other toxins (alcohol) may be additive, further increasing the risk for hepatic failure.
  • Non-dose-related idiosyncratic reactiosn are most commonly related to antibiotics, anticonvulsants, also statins, NSAIDs, herbal/nutritional supplements and drugs such as: isoniazid, flurazepam, methyldopa, intravenous tetracycline
  • Other toxins, Amanita mushrooms account for 90% of mushroom related deaths in the U.S..

Cholestasis 

Cholestasis is a condition that occurs when bile flow from the liver to the small intestine is reduced or blocked. cholestasis occurs when the liver has trouble producing bile or the bile ducts are blocked. Bile is a digestive fluid that helps the body absorb fat and eliminate bilirubin, a waste product from red blood cell breakdown.

Symptoms include:

• Intense itching, especially on the hands and feet
• Dark urine
• Light-colored stools
• Jaundice, which is yellowing of the skin and whites of the eyes
• Nausea
• Loss of appetite

Causes

Cholestasis can be caused by a functional impairment of the liver cells or a blockage in the bile ducts. It can also be a complication of sickle cell disease

Causes of cholestasis include the following:

• Obstructive cholestasis
  • Biliary atresia
  • Congenital bile duct anomalies (choledochal cysts)
  • Cholelithiasis
  • Primary sclerosing cholangitis
  • Infectious cholangitis (cholangitis)
  • Cholangitis associated with Langerhans cell histiocytosis
  • Alagille syndrome
  • Nonsyndromic ductal paucity
• Hepatocellular cholestasis
  • Hepatitis (hepatitis A, hepatitis B, hepatitis C)
  • Alpha1-antitrypsin deficiency
  • Inborn errors of bile acid synthesis
  • Drug-induced cholestasis
  • Total parenteral nutrition (TPN)–associated cholestasis
  • Progressive familial intrahepatic cholestasis 

  (Lin, C. & Valenzuela-Arauj, 2024)

Autoimmune response

Some patients may develop an autoimmune form of hepatitis. The immune system is designed to recognize foreign antigens. The antigens are recognized by antibodies that bind to the antigens and trigger removal from the body. In some cases, autoimmunity develops, and the immune system incorrectly reacts against one's own cells. In autoimmune hepatitis and primary biliary cirrhosis, the immune system attacks and destroys portions of the liver. If unchecked, persistent inflammation can eventually lead to cirrhosis. Patients with autoimmune hepatitis are treated with daily doses of prednisone or prednisolone, which are gradually reduced and withdrawn.