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Diagnosis and Management of Idiosyncratic Drug-induced Liver Injury (DILI)

DILI Types:
 • Intrinsic - predictable, dose dependent
Chronic - ongoing ↑ LFTs ... disease 6-9 mo ... Idiosyncratic #differential ... #algorithm #gastroenterology ... #hepatology
The Liver Consult Primer - Guide to calling a consult
HPI:
 - Start with reason for consult
Gl History - Cirrhosis ... - Vitals - LFTs ... disease work up ... Calling #Referral #Hepatology ... #Gastroenterology
Elevated Liver Enzymes - Differential Diagnosis Algorithm
Severe ALT > 15x ULN
 • Viral
 • Drugs/Toxins
 •
Elevated Liver Enzymes ... - Differential ... • Cholestatic disease ... Infiltrative • Cirrhosis ... • Others #LFTs
Common Etiologies of Cirrhosis

Inflammation

 - Hepatitis B (15 percent)

 - Hepatitis C (47 percent)

 - Schistosomiasis
Etiologies of Cirrhosis ... Nonalcoholic fatty liver ... (Budd-Chiari syndrome ... #Diagnosis #Differential ... #Hepatology #Cirrhosis
Ascites - Differential Diagnosis
Chronic liver disease (cirrhosis or chronic hepatitis) - 80%
Underlying malignancy - 10%
Congestive heart
Ascites - Differential ... Diagnosis Chronic liver ... disease (cirrhosis ... Fitz-Hugh-Curtis syndrome ... #Diagnosis #hepatology
Acute-on-Chronic Liver Failure (ACLF) Clinical Guidelines

ACLF = possibly reversible condition in those with CLD (± cirrhosis)
those with CLD (± cirrhosis ... months without treatment ... disease, liver ... #Failure #Cirrhosis ... #Hepatology #gastroenterology
Hepatomegaly - Differential Diagnosis Algorithm
Malignant
 • Primary Carcinoma
 • Metastases
 • Lymphoma
 • Leukemia
 • Polycythemia
Diagnosis Algorithm ... Non-Malignant • Fatty Liver ... Hemochromatosis • Wilson's Disease ... • Budd-Chiari Syndrome ... Primary Biliary Cirrhosis
Portal Hypertension Classification by site of vascular obstruction
1) Post-hepatic Post-sinusoidal: Budd-Chiari syndrome
2) Intrahepatic Post-sinusoidal: Veno-occlusive disease
3)
Post-sinusoidal: Budd-Chiari syndrome ... 3) Sinusoidal: Cirrhosis ... , Polycystic liver ... Classification #gastroenterology ... #diagnosis #differential
Diagnosis of ascites according to the serum ascites albumin gradient (SAAG)
SAAG ≥ 1.1:
 - Ascitic protein
protein ≤ 2.5 g/dL: Cirrhosis ... , Massive liver ... albumin #gradient #hepatology ... #differential # ... diagnosis #algorithm
Causes of Ascites - Differential Diagnosis Algorithm
Portal Hypertension - Prehepatic:
 • Portal vein thrombosis
 • Splenic
Diagnosis Algorithm ... - Hepatic: • Cirrhosis ... • Infiltrative disease ... • Acute liver ... #Hepatology #causes