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

DILI Types:
 • Intrinsic - predictable, dose dependent
Diagnosis and Management ... Chronic - ongoing ↑ LFTs ... #differential #Diagnosis ... #Management #gastroenterology ... gastroenterology #hepatology
Elevated Liver Function Tests (LFTs) - Differential Diagnosis Framework
Mild (<100-500): 
 • NAFLD
 • Cirrhosis
 •
Tests (LFTs) - ... Differential Diagnosis ... (>1000): • DILI ... Function #Tests #LFTs ... #hepatology #transaminitis
Drug Induced Liver Injury (DILI) - Stepwise Diagnosis Algorithm
DILI suspicion
Features toxic aetiology: Skin involvement, Kidney injury,
Stepwise Diagnosis ... to HDS, drugs, OTC ... for alternative causes ... #Injury #Diagnosis ... #Algorithm #hepatology
Table of Causes of Acute Liver Injury
#Diagnosis #Hepatology #Acute #Liver #Injury #Causes #Differential #Incidence #Table #Failure
Table of Causes ... of Acute Liver Injury ... #Diagnosis #Hepatology ... #Acute #Liver # ... Injury #Causes #
Liver Function Test (LFTs) Elevation
AST - Cardiac and skeletal muscle, kidney, brain
ALT - More specific for
(LFTs) Elevation ... abnormality vs bone Bili ... #FunctionTest #LFTs ... Transaminitis #diagnosis ... #hepatology
The Liver Consult Primer - Guide to calling a consult
HPI:
 - Start with reason for consult
The Liver Consult ... - Vitals - LFTs ... GTT, indirect bili ... shock, sepsis, GIB etc ... Calling #Referral #Hepatology
Liver Enzymes (LFTs) - Causes of Hepatocellular and Cholestatic Liver Injury
Hepatocellular Liver Injury
 • AST/ALT elevation
Liver Enzymes (LFTs ... ) - Causes of Hepatocellular ... #Enzymes #LFTs ... Transaminitis #diagnosis ... #differential #hepatology
Acute-on-Chronic Liver Failure (ACLF) Clinical Guidelines

ACLF = possibly reversible condition in those with CLD (± cirrhosis)
Injury (DILI) ... Hepatitis Procedures Management ... Failure #Cirrhosis #Hepatology ... gastroenterology #management ... #diagnosis
Elevated Transaminases / Transaminitis - Differential Diagnosis

 • Infectious: HAV, HCV, HEV, EBV, HSV, CMV
 •
- Differential Diagnosis ... Trauma: Shock liver ... • Iatrogenic: DILI ... #Differential #Diagnosis ... #causes #hepatology
Liver Function Tests (LFTs) - Normal Values and Interpretation

Alanine aminotransferase (ALT/SGPT) - Liver, cardiac & skeletal
(LFTs) - Normal ... bilirubin (Conjugated/DBili ... Function #Tests #LFTs ... Interpretation #diagnosis ... #hepatology