Peliosis Hepatis ∞ Area

Peliosis Hepatis

Meaning

Peliosis hepatis is a rare vascular condition of the liver characterized by multiple, variably sized, blood-filled cystic spaces within the hepatic parenchyma. These lesions lack a true endothelial lining and result from disrupted sinusoidal integrity. While predominantly hepatic, similar vascular changes can occasionally affect other organs like the spleen.

Context

This condition manifests within the liver’s microcirculation, directly impacting sinusoidal architecture and the perisinusoidal space. It is often associated with specific underlying systemic conditions, including chronic infections, certain medications like anabolic steroids, or exposure to environmental toxins. These vascular anomalies disrupt normal hepatic blood flow and cellular function.

Significance

Clinically, peliosis hepatis is significant due to its potential for severe, life-threatening complications. Patients may experience vague symptoms, or the condition might remain asymptomatic until a critical event like hepatic rupture occurs, leading to acute intra-abdominal hemorrhage. Timely identification is crucial for determining causative factors and preventing adverse outcomes.

Mechanism

The precise pathophysiology involves damage to sinusoidal endothelial cells or obstruction of hepatic venous outflow, leading to localized parenchymal necrosis and subsequent blood pooling. This vascular fragility allows blood to extravasate into the space of Disse, forming progressively enlarging cavernous lacunae. Certain pharmacological agents are recognized inducers of these characteristic hepatic structural alterations.

Application

Diagnosis of peliosis hepatis in clinical practice primarily relies on cross-sectional imaging, such as CT or MRI, which delineate the distinctive cystic lesions. Liver biopsy can confirm diagnosis but carries a notable hemorrhage risk. Management focuses on discontinuing any identified causative agent and providing supportive care. Surgical intervention is reserved for complications like rupture.

Metric

Monitoring peliosis hepatis involves a combination of laboratory and imaging assessments. Liver function tests, including serum transaminases and bilirubin, are evaluated for hepatic compromise indicators. Serial imaging studies are essential for assessing lesion size, number, and stability over time. Clinical observation for symptoms like abdominal pain or jaundice also guides ongoing management.

Risk

The most substantial risks associated with peliosis hepatis involve spontaneous or traumatic rupture of the blood-filled lesions, potentially leading to massive intra-abdominal hemorrhage and life-threatening hypovolemic shock. Progressive liver dysfunction, possibly culminating in hepatic failure or portal hypertension, represents another serious complication, especially with extensive hepatic involvement. Patient education regarding these potential complications is essential.

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