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

DILI Types:
 • Intrinsic - predictable, dose dependent
Idiosyncratic Drug-induced Liver ... - ongoing ↑ LFTs ... or symptoms of liver ... Drug #induced #Liver ... #algorithm #gastroenterology
Elevated Liver Function Tests (LFTs) - Differential Diagnosis Framework
Mild (<100-500): 
 • NAFLD
 • Cirrhosis
 •
Elevated Liver Function ... Cirrhosis • Chronic ... Hepatopathy • Acute ... (Drug-induced liver ... LouLectures #Liver
Acute-on-Chronic Liver Failure (ACLF) Clinical Guidelines

ACLF = possibly reversible condition in those with CLD (± cirrhosis)
Acute-on-Chronic ... Liver Failure ( ... disease, liver ... #Chronic #Liver ... Cirrhosis #Hepatology #gastroenterology
Evaluation abnormal liver tests in pregnancy
- Cholestatic Pattern
- Hepatocellular Pattern

#LFTs #transaminits #pregnancy #obgyn #obstetrics #hepatology #diagnosis
Evaluation abnormal liver ... Hepatocellular Pattern #LFTs ... hepatology #diagnosis #differential ... #algorithm
The Liver Consult Primer - Guide to calling a consult
HPI:
 - Start with reason for consult
The Liver Consult ... - Vitals - LFTs ... current MELD - Chronic ... up - Liver US ... Referral #Hepatology #Gastroenterology
Liver Chemistries - Interpretation of LFTs

R-value: Serum (ALT/ULN ALT) / (Alk phos/ULN ALP)
 • R >
Interpretation of LFTs ... > 2 • NASH, Chronic ... injury: > 3 • Chronic ... chemistry #diagnosis #differential ... transaminitis #LFTs
Patterns of Liver Injury
Transaminase Levels:
  > 50x normal - Ischemic Hepatitis
  > 20x normal
Patterns of Liver ... > 20x normal - Acute ... 5-10x normal - Chronic ... #Patterns #Liver ... Injury #hepatology #LFTs
Upper GI Bleed - Management Algorithm

Upper GI bleed Suspected: Melena, hematemesis, coffee-ground emesis, BRBPR
Initial Stabilization
Concern for
Algorithm Upper ... Stabilization Concern for Liver ... GAVE (idiopathic, liver ... UGIB #GIBleed #Differential ... #gastroenterology
Hepatocellular Liver Injury - Differential Diagnosis Framework:
Liver Injury → liver test abnormalities without evidence of liver
Hepatocellular Liver ... Injury → liver ... Hepatocellular Liver ... Diagnosis #hepatology #algorithm ... Transaminitis #LFTs
Acute Liver Injury - Differential Diagnosis Algorithm

Vascular Causes of Acute Liver Injury: 
 • Hepatic vein:
Acute Liver Injury ... - Differential ... Diagnosis Algorithm ... > 2 • NASH, Chronic ... #diagnosis #algorithm