Hepatic necrosis can come from a variety of causes. Drug injury is probably most common, and offending agents include acetaminophen, isoniazid, halothane, cocaine, anabolic steroids and herbs. Toxins include Amanita phalloides (mushroom), carbon tetrachloride and aflatoxin. Metabolic causes include Wilson disease and acute fatty liver of pregnancy. Infectious agents include hepatitis B and delta, and leptospira.
Laboratory abnormalities will likely be mixed (hepatitis and cholestasis) and removal of the offending agent is indicated when possible. In the photograph above, note the tan/yellow discoloration of the left lateral segment of this patient’s liver. This is the necrotic tissue, in contrast with the healthier, pink parenchyma. On histology you are likely to see acellular debris and collapse of the normal architecture. When the cause is a drug, the necrosis may predominate in zone 3 (central vein).
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