Inflammatory effect on the gastrointestinal system associated with COVID-19

Figure 2 Proposed process of liver damage. Before severe acute respiratory syndrome-coronavirus-2 infection, there are risk factors considered that could be poor prognostic factors, such as chronic diseases, the use of drugs that affect the liver and the inflammation process. The virus can infect the liver through the portal vein. There are three proposed mechanisms of liver damage: inflammation induced by cytokine storm and activation of hepatic immunity, angiotensin-converting enzyme 2-mediated direct viral infection of hepatocytes, epithelial cells, and cholangiocytes, and drug hepatotoxicity mediated by some antivirals employed for coronavirus disease-2019 (COVID-19) treatment. The three mechanisms culminate in altered coagulation, hepatic ischemia, and elevation of aminotransferases and bilirubin levels. Following this, the incidence of liver damage derived from COVID-19 is up to 53%, which could develop cholestasis and reach high mortality risk. ACE2: Angiotensin-converting enzyme 2.