Chapter 24 - The Liver in Systemic Disease

Abstract

A variety of systemic disorders may result in hepatic dysfunction from direct hepatic involvement or infiltration or as a nonspecific manifestation, as in sepsis. Systemic disorders that may affect the liver include heart failure with hepatic congestion and ischemic hepatitis due to systemic hypotension. Connective tissue disorders may be implicated in hepatic dysfunction in the form of nonspecific elevation of serum aminotransfersease levels or an associated entity, such as primary biliary cholangitis in patients with systemic sclerosis. Infiltration of the liver may result from a neoplastic process such as lymphoma or leukemia, miliary tuberculosis, or other granulomatous diseases such as sarcoidosis. Drug-induced liver injury is another consideration. Hepatic dysfunction is typically mild in systemic disorders, but its presence can have important consequences, as in Budd-Chiari syndrome complicating antiphospholipid syndrome. The diagnostic approach management is guided by the severity and pattern of hepatic dysfunction as well as the underlying disorder.