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hepatology diagnosis differential transaminitis hepatitis management gastroenterology aclf causes chemistry chronic cirrhosis drug druginduced failure function hepatocellular idiosyncratic induced interpretation
Diagnosis and Management of Idiosyncratic Drug-induced Liver Injury (DILI) DILI Types: • Intrinsic - predictable, dose dependent
Injury (DILI) ... dose dependent injury ... Chronic - ongoing ↑ LFTs ... or symptoms of liver ... gastroenterology #algorithm
Elevated Liver Function Tests (LFTs) - Differential Diagnosis Framework Mild (<100-500): • NAFLD • Cirrhosis •
Tests (LFTs) - ... Hepatopathy • Acute ... (>1000): • DILI ... injury) • Ischemic ... Function #Tests #LFTs
Drug Induced Liver Injury (DILI) - Stepwise Diagnosis Algorithm DILI suspicion Features toxic aetiology: Skin involvement, Kidney injury,
Injury (DILI) - ... Stepwise Diagnosis Algorithm ... HEV, EBV, CMV), Alcohol-related ... dechallenge • Acute ... #Algorithm #hepatology
Acute Liver Injury - Differential Diagnosis Algorithm Vascular Causes of Acute Liver Injury: • Hepatic vein:
Acute Liver Injury ... Differential Diagnosis Algorithm ... Liver Injury: ... Liver Injury: ... ALT Ratios: • Alcoholic
Liver Chemistries - Interpretation of LFTs R-value: Serum (ALT/ULN ALT) / (Alk phos/ULN ALP) • R >
Interpretation of LFTs ... ALT Ratios: • Alcoholic ... Unconjugated Bili ... > 90% of Total Bili ... transaminitis #LFTs
Acute-on-Chronic Liver Failure (ACLF) Clinical Guidelines ACLF = possibly reversible condition in those with CLD (± cirrhosis)
Acute-on-Chronic ... Liver Failure ( ... Failure Infections Alcohol-Associated ... Injury (DILI) ... EmoryGastroHep #ACLF #Acute
Patterns of Liver Injury Transaminase Levels: > 50x normal - Ischemic Hepatitis > 20x normal
Patterns of Liver ... Injury Transaminase ... > 20x normal - Acute ... #Patterns #Liver ... #LFTs #transaminitis
Causes of Acute Liver Injury - Differential Diagnosis Hepatocellular - Liver Parenchyma • Infectious: Hepatitis C, A,
Liver Injury - Differential ... HSV • Toxic: Alcohol ... Medication, Pregnancy, Alcoholic ... #Injury #Differential ... #algorithm #hepatology
Hepatocellular Liver Injury - Differential Diagnosis Framework: Liver Injury → liver test abnormalities without evidence of liver
Injury - Differential ... Injury → liver ... Drugs (MDMA), Alcohol ... Diagnosis #hepatology #algorithm ... Transaminitis #LFTs
Alcoholic Hepatitis - Management Algorithm Assess Eligibility for Treatment: - Maddrey Discriminant Function ≥ (or possibly MELD
Alcoholic Hepatitis ... - Management Algorithm ... Treatment: - Acute ... kidney injury with ... HCV, DILI, HCC,
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