Difference between revisions of "Drug-induced liver disease"

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*[http://livertox.nih.gov Drug-liver toxicity (nih.gov)].
*[http://livertox.nih.gov Drug-liver toxicity (nih.gov)].


[[Category:Medical liver diseases]]
[[Category:Medical liver disease]]

Revision as of 15:05, 5 September 2014

Drug-induced liver disease, also drug-induced liver toxicity, is relatively common.

Drug reactions in general are dealt with in drug toxicity.

General

  • Drugs can do almost anything; may include: granulomata, bile duct loss, cholestasis, ischemic type injury.
  • Effects can be delayed -- temporal relationship not always obvious.

Microscopic

Features:

Images

  • Drug-induced hepatitis - low mag. (WC)

  • Drug-induced hepatitis - intermed. mag. (WC)

  • Drug-induced hepatitis - high mag. (WC)

Specific patterns

Acute hepatits:

  • Related to Rx - most often antibiotics.

Steatohepatitis/steatosis:[2]

  • Amiodarone - cardiac arrhythmias.
  • Tamoxifen - breast cancer.
  • Carbamazepine - seizures.

Cholestasis:

Specific drugs

Acetaminophen:

  • Zone 3 necrosis.
    • Tx: N-acetylcysteine (NAC).[5]
      • NAC is an endogenous precursor to glutathione.[6]
    • Hepatotoxicity from N-acetyl-p-benzoquinoneimine (NAPQI) due to depletion of glutathione.[5]

Methotrexate - chronic use:

  • Histology:[7]
    • Features of steatohepatitis.
      • Zone III steatosis.
      • Ballooning degeneration.
    • Portal inflammation with mixed population (lymphocytes, macrophages, PMNs).
    • Nuclear atypia (hyperchromasia, pleomorphism, vacuolation).
      • Described as just nuclear size variation by some.[8]

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LIVER, MEDICAL CORE BIOPSIES:
- MILD STEATOHEPATITIS AND MILD FIBROSIS (1/4).
- MILD TO MODERATE STEATOSIS.

COMMENT:
The findings are compatible with nonalcoholic steatohepatitis (NASH), alcoholic
steatohepatitis (ASH) or drug effect. The steatosis is periportal predominant; this 
is not typical for NASH or ASH. Clinical correlation and review of medications 
is suggested.

See also

References

  1. ↑ Tadrous, Paul.J. Diagnostic Criteria Handbook in Histopathology: A Surgical Pathology Vade Mecum (1st ed.). Wiley. pp. 166. ISBN 978-0470519035.
  2. ↑ Grieco, A.; Forgione, A.; Miele, L.; Vero, V.; Greco, AV.; Gasbarrini, A.; Gasbarrini, G.. "Fatty liver and drugs.". Eur Rev Med Pharmacol Sci 9 (5): 261-3. PMID 16237810.
  3. ↑ Stadlmann, S.; Portmann, S.; Tschopp, S.; Terracciano, LM. (Nov 2012). "Venlafaxine-induced cholestatic hepatitis: case report and review of literature.". Am J Surg Pathol 36 (11): 1724-8. doi:10.1097/PAS.0b013e31826af296. PMID 23073329.
  4. ↑ Vilas-Boas, F.; Gonçalves, R.; Sobrinho Simões, M.; Lopes, J.; Macedo, G. (Oct 2012). "Thalidomide-induced acute cholestatic hepatitis: case report and review of the literature.". Gastroenterol Hepatol 35 (8): 560-6. doi:10.1016/j.gastrohep.2012.05.007. PMID 22789729.
  5. ↑ 5.0 5.1 Millea PJ (August 2009). "N-acetylcysteine: multiple clinical applications". Am Fam Physician 80 (3): 265–9. PMID 19621836.
  6. ↑ URL: http://www.mskcc.org/mskcc/html/69310.cfm. Accessed on: 19 October 2010.
  7. ↑ Burt, Alastair D.;Portmann, Bernard C.;Ferrell, Linda D. (2006). MacSween's Pathology of the Liver (5th ed.). Churchill Livingstone. pp. 715. ISBN 978-0-443-10012-3.
  8. ↑ MG. 23 September 2009.

External links

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