Drug induced liver injury physical examination: Difference between revisions
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{{Drug induced liver injury}} | {{Drug induced liver injury}} | ||
{{CMG}} {{AE}} | {{CMG}}; {{AE}} {{rachita}} | ||
==Overview== | ==Overview== | ||
Patients with drug induced liver injury usually appear normal on physical exam, unless they are presenting in [[acute liver failure]].<ref name="pmid22541696">{{cite journal| author=Davern TJ| title=Drug-induced liver disease. | journal=Clin Liver Dis | year= 2012 | volume= 16 | issue= 2 | pages= 231-45 | pmid=22541696 | doi=10.1016/j.cld.2012.03.002 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22541696 }} </ref> Some patients may also present in [[chronic liver failure]] due to rare drugs associated with liver [[scarring]], e.g. [[methotrexate]].<ref name="pmid7986233">{{cite journal| author=Fries JF, Ramey DR, Singh G| title=Suggested guidelines for monitoring liver toxicity in rheumatoid arthritis patients treated with methotrexate: comment on the article by Kremer et al. | journal=Arthritis Rheum | year= 1994 | volume= 37 | issue= 12 | pages= 1829-30 | pmid=7986233 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7986233 }} </ref> | |||
==Physical Examination== | ==Physical Examination== | ||
===General Appearance=== | ===General Appearance=== | ||
The general appearance of the patient will depend on the severity of the condition. | |||
===Vital Signs=== | ===Vital Signs=== | ||
The patient may be [[febrile]]. | |||
===Skin=== | ===Skin=== | ||
The skin may be [[jaundice]]d. There may also be [[excoriation]]s from [[pruritis]] due to drug induced [[cholestatic]] injury. | |||
===Abdomen=== | ===Abdomen=== | ||
There may be [[right upper quadrant]] [[tenderness]]. There may be [[ascites]] in cases of chronic drug induced liver injury. | |||
===Extremities=== | ===Extremities=== | ||
There may be stigmata of chronic drug induced liver injury including [[cachexia]], [[spider angiomata]], and [[palmar erythema]]. | |||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
Latest revision as of 17:38, 26 October 2016
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Differentiating Drug Induced Liver Injury from other Diseases |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Rachita Navara, M.D. [2]
Overview
Patients with drug induced liver injury usually appear normal on physical exam, unless they are presenting in acute liver failure.[1] Some patients may also present in chronic liver failure due to rare drugs associated with liver scarring, e.g. methotrexate.[2]
Physical Examination
General Appearance
The general appearance of the patient will depend on the severity of the condition.
Vital Signs
The patient may be febrile.
Skin
The skin may be jaundiced. There may also be excoriations from pruritis due to drug induced cholestatic injury.
Abdomen
There may be right upper quadrant tenderness. There may be ascites in cases of chronic drug induced liver injury.
Extremities
There may be stigmata of chronic drug induced liver injury including cachexia, spider angiomata, and palmar erythema.
References
- ↑ Davern TJ (2012). "Drug-induced liver disease". Clin Liver Dis. 16 (2): 231–45. doi:10.1016/j.cld.2012.03.002. PMID 22541696.
- ↑ Fries JF, Ramey DR, Singh G (1994). "Suggested guidelines for monitoring liver toxicity in rheumatoid arthritis patients treated with methotrexate: comment on the article by Kremer et al". Arthritis Rheum. 37 (12): 1829–30. PMID 7986233.