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Drug-induced liver disease (view source)
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'''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: | |||
*Non-specific findings. | |||
**+/-Eosinophils<ref>{{Ref DCHH|166}}</ref> - '''significant suggestive finding'''. | |||
**+/-Steatosis - periportal macrovesicular, microvesicular. | |||
**+/-[[Vanishing bile duct syndrome]]. | |||
**+/-[[Granuloma]]s. | |||
===Images=== | |||
<gallery> | |||
Image:Drug-induced_hepatitis_low_mag.jpg | Drug-induced hepatitis - low mag. (WC) | |||
Image:Drug-induced_hepatitis_intermed_mag.jpg | Drug-induced hepatitis - intermed. mag. (WC) | |||
Image:Drug-induced hepatitis high mag.jpg | Drug-induced hepatitis - high mag. (WC) | |||
</gallery> | |||
===Specific patterns=== | |||
Acute hepatits: | |||
*Related to Rx - most often antibiotics. | |||
[[Steatohepatitis]]/[[steatosis]]:<ref name=pmid16237810>{{Cite journal | last1 = Grieco | first1 = A. | last2 = Forgione | first2 = A. | last3 = Miele | first3 = L. | last4 = Vero | first4 = V. | last5 = Greco | first5 = AV. | last6 = Gasbarrini | first6 = A. | last7 = Gasbarrini | first7 = G. | title = Fatty liver and drugs. | journal = Eur Rev Med Pharmacol Sci | volume = 9 | issue = 5 | pages = 261-3 | month = | year = | doi = | PMID = 16237810 }}</ref> | |||
*Amiodarone - cardiac arrhythmias. | |||
*Tamoxifen - [[breast cancer]]. | |||
*Carbamazepine - seizures. | |||
[[Cholestasis]]: | |||
*Venlafaxine - depression.<ref name=pmid23073329>{{Cite journal | last1 = Stadlmann | first1 = S. | last2 = Portmann | first2 = S. | last3 = Tschopp | first3 = S. | last4 = Terracciano | first4 = LM. | title = Venlafaxine-induced cholestatic hepatitis: case report and review of literature. | journal = Am J Surg Pathol | volume = 36 | issue = 11 | pages = 1724-8 | month = Nov | year = 2012 | doi = 10.1097/PAS.0b013e31826af296 | PMID = 23073329 }}</ref> | |||
*Thalidomide - [[multiple myeloma]].<ref name=pmid22789729>{{Cite journal | last1 = Vilas-Boas | first1 = F. | last2 = Gonçalves | first2 = R. | last3 = Sobrinho Simões | first3 = M. | last4 = Lopes | first4 = J. | last5 = Macedo | first5 = G. | title = Thalidomide-induced acute cholestatic hepatitis: case report and review of the literature. | journal = Gastroenterol Hepatol | volume = 35 | issue = 8 | pages = 560-6 | month = Oct | year = 2012 | doi = 10.1016/j.gastrohep.2012.05.007 | PMID = 22789729 }}</ref> | |||
===Specific drugs=== | |||
Acetaminophen: | |||
*Zone 3 necrosis. | |||
**Tx: N-acetylcysteine (NAC).<ref name=pmid19621836>{{cite journal |author=Millea PJ |title=N-acetylcysteine: multiple clinical applications |journal=Am Fam Physician |volume=80 |issue=3 |pages=265–9 |year=2009 |month=August |pmid=19621836 |doi= |url=}}</ref> | |||
***NAC is an endogenous precursor to glutathione.<ref>URL: [http://www.mskcc.org/mskcc/html/69310.cfm http://www.mskcc.org/mskcc/html/69310.cfm]. Accessed on: 19 October 2010.</ref> | |||
**Hepatotoxicity from ''N-acetyl-p-benzoquinoneimine (NAPQI)'' due to depletion of ''glutathione''.<ref name=pmid19621836>{{cite journal |author=Millea PJ |title=N-acetylcysteine: multiple clinical applications |journal=Am Fam Physician |volume=80 |issue=3 |pages=265–9 |year=2009 |month=August |pmid=19621836 |doi= |url=}}</ref> | |||
Methotrexate - chronic use: | |||
*Histology:<ref>{{Ref MacSween|715}}</ref> | |||
**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.<ref>MG. 23 September 2009.</ref> | |||
==Sign out== | |||
<pre> | |||
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. | |||
</pre> | |||
==See also== | |||
*[[Medical liver disease]]. | |||
==References== | |||
{{Reflist|2}} | |||
==External links== | |||
*[http://livertox.nih.gov Drug-liver toxicity (nih.gov)]. | |||
[[Category:Medical liver diseases]] | |||