Drug induced liver injury classification: Difference between revisions
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{{Drug induced liver injury}} | {{Drug induced liver injury}} | ||
{{CMG}}; {{AE}} | {{CMG}}; {{AE}} {{rachita}} | ||
==Overview== | ==Overview== | ||
There are various classification systems in place for drug induced liver injury.<ref name="pmid26125428">{{cite journal| author=Fisher K, Vuppalanchi R, Saxena R| title=Drug-Induced Liver Injury. | journal=Arch Pathol Lab Med | year= 2015 | volume= 139 | issue= 7 | pages= 876-87 | pmid=26125428 | doi=10.5858/arpa.2014-0214-RA | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26125428 }} </ref> | |||
==Classification== | ==Classification== | ||
Drug induced liver injury can be classified based on: | |||
===Clinical presentation:=== | |||
-Hepatocellular injury | |||
*elevation of serum transaminases > 2-5 times the upper limit of normal | |||
*may have hyperbilirubinemia | |||
*may have abnormal synthetic function tests (e.g. International Normalized Ratio, albumin) | |||
-Cholestatic injury | |||
*elevation of alkaline phosphatase > 3 times the upper limit of normal | |||
*hyperbilirubinemia | |||
*may have abnormal synthetic function tests (e.g. International Normalized Ratio, albumin) | |||
-Mixed injury | |||
*both alkaline phosphatase and transaminases are elevated in roughly equal proportion, and/or an alanine aminotransferase to alkaline phosphatase ratio between 2-5 | |||
===Mechanism:=== | |||
-Dose-dependent hepatotoxicity | |||
*e.g. acetaminophen-induced centrilobular necrosis | |||
-Idiosyncratic hepatotoxicity | |||
*e.g. stimulation of immune reponse by biologic agents, indepdenetent of dose | |||
*e.g. altered host genes involved in drug metabolism | |||
===Histologic findings:=== | |||
-Hepatitis (hepatocellular injury) | |||
-Cholestasis | |||
-Granulomatous | |||
-Steatosis | |||
-Fibrosis | |||
==References== | ==References== | ||
Revision as of 22:29, 3 August 2016
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Drug induced liver injury Microchapters |
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Differentiating Drug Induced Liver Injury from other Diseases |
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Diagnosis |
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Treatment |
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Case Studies |
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Drug Induced Liver Injury On the Web |
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American Roentgen Ray Society Images of Drug induced liver injury |
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Risk calculators and risk factors for Drug induced liver injury |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Rachita Navara, M.D. [2]
Overview
There are various classification systems in place for drug induced liver injury.[1]
Classification
Drug induced liver injury can be classified based on:
Clinical presentation:
-Hepatocellular injury
- elevation of serum transaminases > 2-5 times the upper limit of normal
- may have hyperbilirubinemia
- may have abnormal synthetic function tests (e.g. International Normalized Ratio, albumin)
-Cholestatic injury
- elevation of alkaline phosphatase > 3 times the upper limit of normal
- hyperbilirubinemia
- may have abnormal synthetic function tests (e.g. International Normalized Ratio, albumin)
-Mixed injury
- both alkaline phosphatase and transaminases are elevated in roughly equal proportion, and/or an alanine aminotransferase to alkaline phosphatase ratio between 2-5
Mechanism:
-Dose-dependent hepatotoxicity
- e.g. acetaminophen-induced centrilobular necrosis
-Idiosyncratic hepatotoxicity
- e.g. stimulation of immune reponse by biologic agents, indepdenetent of dose
- e.g. altered host genes involved in drug metabolism
Histologic findings:
-Hepatitis (hepatocellular injury) -Cholestasis -Granulomatous -Steatosis -Fibrosis
References
- ↑ Fisher K, Vuppalanchi R, Saxena R (2015). "Drug-Induced Liver Injury". Arch Pathol Lab Med. 139 (7): 876–87. doi:10.5858/arpa.2014-0214-RA. PMID 26125428.