Presentation
HLA-DR6 was present in four of five patients (80%) with chlorpromazine hepatitis, compared to 22% in controls. In conclusion, the HLA phenotype does not contribute significantly to idiosyncratic drug-induced hepatitis considered collectively. [ncbi.nlm.nih.gov]
Hundreds of brand-new illustrations clearly present key aspects of liver disease. [books.google.de]
Younger patients present most commonly with a hepatocellular pattern of injury, whereas older patients mostly present with a cholestatic pattern of liver injury. 3 Some studies have found that women have a greater risk of developing DILI than men. 13 [mdedge.com]
Always consider drugs as a cause of any patient presenting with hepatitis in order to provide early effective management. [patient.info]
The present case suggests that liver injury associated with vildagliptin is drug-specific in view of several findings that are not reported in the literature. [care.diabetesjournals.org]
Entire Body System
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Malaise
These incidents usually occur during the first 6 months of treatment and are preceded by nonspecific symptoms such as malaise, weakness, lethargy, facial edema, anorexia, vomiting, and even loss of seizure control. [emedicine.medscape.com]
Initially, anorexia, nausea, and malaise may occur, followed by pruritus in some but not all patients. [clinicalgate.com]
Urogenital
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Dark Urine
Some of the common symptoms are: nausea vomiting headache anorexia jaundice clay color stools dark urine hepatomegaly Diagnosis Diagnosis is typically made through a physical exam along with a patient history to identify any possible hepatotoxins. [medical-dictionary.thefreedictionary.com]
urine Diarrhea Fatigue Fever Headache Jaundice Loss of appetite Nausea and vomiting Rash White or clay-colored stools Exams and Tests You will have blood tests to check liver function. [mountsinai.org]
Later, overt evidence of liver damage, such as jaundice, dark urine and an enlarged and tender liver, may develop. Two general pathogenic mechanisms are recognised: Predictable or direct: usually promptly follows an exposure to a new medication. [patient.info]
Patients should be advised to promptly report any new onset symptoms such as yellowing of their eyes, abdominal pain / discomfort, nausea / vomiting, itching, or dark urine. [utahgastroblog.com]
Symptoms of liver damage include 5, 18 : Dark Urine. Fever. Pain in the abdomen. Nausea. Vomiting. Headache. Diarrhea. White stools. Rash. Build-up of fluid in the abdominal cavity. Jaundice (yellowing of eyes and skin). Enlarged liver. Fatigue. [drugabuse.com]
Workup
[…] cardiovascular causes, especially right-sided heart failure Cholecystitis Cholangitis Budd-Chiari syndrome Alcoholic liver disease Cholestatic liver disease Pregnancy-related conditions of liver Malignancy Wilson disease Hemochromatosis Coagulation disorders Workup [emedicine.medscape.com]
HLA Type
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HLA-DR2
The prevalences of HLA-DR2, DR6, and B8 were similar in the 71 patients and in controls. [ncbi.nlm.nih.gov]
In a study of DILI associated with a range of different drugs, a small but not statistically significant increase in incidence in frequency of both HLA-DR2 and another serotype, HLA-DR6, was seen [ 12 ]. [genomemedicine.biomedcentral.com]
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HLA-B8
Abstract Possible associations between particular human leucocyte antigen molecules and immunoallergic hepatitis have been suggested previously (HLA-A11 in halothane hepatitis, HLA-DR6 and DR2 in nitrofurantoin hepatitis, HLA-B8 in clometacin hepatitis [ncbi.nlm.nih.gov]
Treatment
[…] liver injury, and changes in hepatitis C virus treatment and hot-button concerns about access to care. [books.google.de]
treatments 19-73 days (median 28). [journals.plos.org]
A viral hepatitis was excluded and valproic acid treatment was stopped. Upon normalisation of the liver tests, temozolomide treatment was resumed without perturbation of the liver tests. [scholars.northwestern.edu]
Prognosis
Prognosis Usually the symptoms will go away after the drug has been eliminated due to the liver repairing itself. A full recovery is typically expected unless it wasn't treated quickly resulting in more liver damage being done than normal. [medical-dictionary.thefreedictionary.com]
Outlook (Prognosis) Drug-induced liver injury most often goes away within days or weeks after you stop taking the drug that caused it. Possible Complications Rarely, drug-induced liver injury can lead to liver failure. [mountsinai.org]
The risk is higher in women. [ 6, 7 ] Prognosis Usually symptoms subside when the causative drug has been discontinued and drug-related hepatitis subsides within days or weeks after the offending drug is stopped. [patient.info]
The dose toxic to the liver is quite variable from person to person and is often thought to be lower in chronic alcoholics. [16] [17] Measurement of blood level is important in assessing prognosis, higher levels predicting a worse prognosis. [en.wikipedia.org]
The prognosis is highly variable depending on the patient's presentation and stage of liver damage. [emedicine.medscape.com]
Etiology
ICD-10-CM Codes › K00-K95 Diseases of the digestive system › K70-K77 Diseases of liver › Use Additional Use Additional Help Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology. [icd10data.com]
Etiology of newonset jaundice: how often is it caused by idiosyncratic druginduced liver injury in the United States? Am J Gastroenterol 2007;102:558-562. 9. Jinjuvadia K, Kwan W, Fontana RJ. [degruyter.com]
This categorization allows testing for competing etiologies in a systematic approach. [utahgastroblog.com]
[…] drug exposure varies from hours to months Clinical manifestations range from asymptomatic deranged liver function to fulminant hepatic failure and death Mimic all forms of acute, chronic, vascular or neoplastic liver diseases that are caused by other etiologies [pathologyoutlines.com]
Epidemiology
New epidemiologic data suggest that approximately 20 new cases of DILI per 100,000 persons occur each year. Idiosyncratic DILI accounts for 11% of the cases of acute liver failure in the United States. [mayoclinic.pure.elsevier.com]
Epidemiology and individual susceptibility to adverse drug reactions affecting the liver. Semin Liver Dis 2002;22:145-155. 7. Temple RJ, Himmel MH. Safety of newly approved drugs: implications for prescribing. JAMA 2002;287:2273-2275. 8. [degruyter.com]
About 10% of cases are idiosyncratic. [ 1 ] Epidemiology A very large number of drugs have been implicated as a potential cause of drug-induced hepatitis but with variable risk of both frequency and severity. [patient.info]
Epidemiology Adverse drug reactions caused by immune and nonimmune mechanisms are a major cause of morbidity and mortality worldwide. [aafp.org]
Epidemiology and individual susceptibility to adverse drug reactions affecting the liver. Seminars Liver Dis., 22: 145-155. PubMed Lee, W.M. and W.T. Denton, 1989. [scialert.net]
Pathophysiology
New to this edition are artwork and figures that illustrate the pathophysiology of many conditions in a full-color format. [books.google.de]
Definition / general Drug / toxin reactions can be intrinsic or predictable, where they are dose dependent (e.g. acetaminophen ); or idiosyncratic and unpredictable, where they are dose independent (e.g. isoniazid) Pathophysiology Underlying mechanisms [pathologyoutlines.com]
The latter are unpredictable and dose-independent and may be related to either toxic or autoimmune pathophysiology. [karger.com]
[…] and mechanisms of drug-induced liver injury Pathophysiologic mechanisms The pathophysiologic mechanisms of hepatotoxicity are still being explored and include both hepatocellular and extracellular mechanisms. [emedicine.medscape.com]
Prevention
[…] icon highlights health promotion and disease prevention information.- Elderly tips and Pediatric tips emphasize important variations in these patient populations. [books.google.de]
Monitoring for and recognition of drug-induced hepatotoxicity may prevent some cases of acute hepatic failure. [nejm.org]
Preventing Liver Damage There are many different things you can do in order to prevent liver damage. Be mindful of the following tips 5, 7 : Don’t take more than the recommended dose of acetaminophen or other non-prescription medications. [drugabuse.com]
Hepatitis E Whether IG prevents hepatitis E remains undetermined. [clinicalgate.com]
Prevention If there is a history of liver damage certain medications should not be taken. Doctors will be familiar with these. Resources Books Feldman, Sleisenger, and Scharschmidt. "Liver Diseases Caused by Drugs, Anesthetics, and Toxins." [medical-dictionary.thefreedictionary.com]