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==Diagnosis==
==Diagnosis==
Diagnosis of ESH and evaluation of hepatic function may be achieved using three types of diagnostic test. Serum biochemistry may indicate the following abnormalities:
Diagnosis of ESH and evaluation of hepatic function may be achieved using a combination of clinical history, abrupt onset of clinical signs and diagnostic tests indicative of hepatic insufficiency. Serum biochemistry may indicate the following abnormalities:
* Increased conjugated and unconjugated bilirubin
* Increased conjugated and unconjugated bilirubin
* Increased liver enzymes- SDH, AST, GGT and ALP
* Increased liver enzymes- SDH, AST, GGT and ALP
* Hypoglycaemia
* Hypoglycaemia
* Reduced urea
* Increased urea
Ultrasound may reveal a smaller than normal liver with a loss of parenchymal structure and enlarged bile ducts. In several studies, biopsy is considered as the ‘gold standard’ technique for definitive diagnosis of hepatic disease. Biopsy is usually performed on the right hand side, between the twelth and fourteenth intercostal spaces. A coagulation profile is often performed prior to performing the procedure.
==Pathology==
==Pathology==
Post mortem examination often shows generalised icterus and ascites, with an enlarged and pale liver. Histologically there may signs of acute hepatocellular degeneration including centrilobular to midzonal necrosis with mononuclear cell accumulation within the portal triads. Contusions, lacerations or fractures may be present if the disease has had a violent clinical course.
Post mortem examination often shows generalised icterus and ascites, with an enlarged and pale liver. Histologically there may signs of acute hepatocellular degeneration including centrilobular to midzonal necrosis with mononuclear cell accumulation within the portal triads. Contusions, lacerations or fractures may be present if the disease has had a violent clinical course.
==Treatment==
==Treatment==