hepatic and biliary disorders
Liver Injury Caused by Drugs
Diagnosis of Drug Related Liver Injury
Identification of characteristic patterns of laboratory abnormalities Exclusion of other causes Presentation varies widely, ranging from absent or nonspecific symptoms (eg, malaise, nausea, anorexia) to jaundice, impaired hepatic synthesis, and encephalopathy. Early recognition of drug-induced liver injury (DILI) improves prognosis. Key to the diagnosis of DILI are identification of a potential hepatotoxin, a pattern of Laboratory Tests of the Liver and Gallbladder abnormalities that is characteristic of the substance (its signature), and injury onset that is temporally consistent with the offending hepatotoxin's typical profile. Possible causative agents can be evaluated using the LiverTox database. This easily accessible internet database is funded by the National Institutes of Health. It includes information on the likelihood that a substance causes DILI, the pattern of injury, the time course to injury, and the suspected recovery period. It also includes links to case reports on potential causative agents. (The database can be accessed at the following link: Because there is no confirmatory diagnostic test, other causes of liver disease, especially viral, biliary, alcoholic, autoimmune, and metabolic causes, need to be excluded ( Diagnosis reference ). Drug rechallenge should be avoided. Suspected cases of DILI should be reported to the Food and Drug Administration’s (FDA’s) adverse drug reaction monitoring program ( Do not rechallenge with a drug suspected of causing liver injury. 1.European Association for the Study of the Liver: EASL clinical practice guidelines: Drug-induced liver injury.J Hepatol70(6):1222-1261, 2019. doi: 10.1016/j.jhep.2019.02.014 