Bacterial infections may cause liver dysfunction through direct infection or as a result of inflammatory mediators from bacterial infections in other body sites. This is not surprising given the extent of the hepatic vascular supply, as well as significant venous drainage from the gastrointestinal system. Abnormal liver functions tests (LFTs) may occur in a variety of septic conditions not directly involving the liver, such as in community-acquired pneumonia. Neonates and infants under 1 year are especially susceptible to liver dysfunction in septic states, due to low bile salt-independent bile flow. Signs and symptoms include jaundice with fever, rigors, and confusion. Abnormalities in LFTs often appear 24-48 h after the onset of initial symptoms, and include mild elevations in transaminases and alkaline phosphatase, with significant hyperbilirubinemia. Canalicular cholestasis, focal hepatocyte fat droplets, and periportal cell infiltrates are commonly encountered histological findings. Sinusoidal leukostasis and adherence to hepatic endothelial cells result from release of TNF-alpha, IL-1, IL-8, and activation of C5a.
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