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Oxford Textbook of Medicine (5 ed.)

Edited by David A. Warrell, Timothy M. Cox, John D. Firth

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Latest update

The November 2012 update sees updates to over 70 chapters, focusing on Neurology and Gastroenterology. This update also incorporates a selection of 29 Case Histories taken from related titles in the Oxford Case Histories series, linked to from related chapters. Each case includes several questions followed by detailed answers and discussion to enhance diagnostic and clinical understanding.

Neurology updates include substantial updates to key chapters and new material on a wide range of topics including spinal cord injury, autonomic nervous system disorders, and inherited neurodegenerative diseases. 

Gastroenterology updates include extensive revisions of key chapters on liver failure and acute pancreatitis and new material on a wide range of matters, ranging from the common to the rare: including surgical treatments for colonic diverticular disease, antibody tests for immune disorders, and a revised treatment algorithm for small bowel bacterial overgrowth.

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Publisher:
Oxford University Press
Print Publication Date:
May 2010
Print ISBN-13:
9780199204854
Published to Oxford Medicine:
May 2012
DOI:
10.1093/med/9780199204854.001.1

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Oxford University Press makes no representation, express or implied, that the drug dosages in this book are correct. Readers must therefore always check the product information and clinical procedures with the most up to date published product information and data sheets provided by the manufacturers and the most recent codes of conduct and safety regulations. The authors and the publishers do not accept responsibility or legal liability for any errors in the text or for the misuse or misapplication of material in this work. Except where otherwise stated, drug dosages and recommendations are for the non-pregnant adult who is not breastfeeding.

Contents

Hepatic granulomas

Chapter:
Hepatic granulomas
Author(s):

C.W.N. Spearman,

M.W. Sonderup,

S.J. Saunders

DOI:
10.1093/med/9780199204854.003.152207_update_001

Update:

Description of hepatic manifestations of immune reconstitution inflammatory syndrome in HIV/AIDS.

Updated on 30 November 2011. The previous version of this content can be found here.

Granuloma formation occurs when persistent antigenaemia or poorly degradable antigens, such as chemicals or toxins, provide an ongoing stimulus that results in the focal accumulation of activated lymphocytes and macrophages, with the macrophages undergoing epithelioid transformation.

The diagnosis of granulomatous hepatitis is usually made during the investigation of a systemic illness, often presenting as pyrexia of unknown origin. Serum liver transaminases are frequently normal, but alkaline phosphatase and γ-glutamyltransferase levels may be elevated. The histomorphology of the granuloma, their distribution in the liver and special stains, e.g. Ziehl–Neelsen for mycobacteria and methenamine silver for fungi, may yield a definite diagnosis.

The causes of hepatic granulomas vary depending on the patient population and country studied. In the developed world most cases are due to sarcoidosis, primary biliary cirrhosis or are drug-induced, whilst infectious causes such as mycobacterial infections, schistosomiasis and AIDS-related infections predominate in the developing world.

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