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

DILI Types:
 • Intrinsic - predictable, dose dependent
presentation • Chronic ... - ongoing ↑ LFTs ... disease 6-9 mo ... Diagnosis #Management #gastroenterology ... #algorithm #gastroenterology
Elevated Liver Function Tests (LFTs) - Differential Diagnosis Framework
Mild (<100-500): 
 • NAFLD
 • Cirrhosis
 •
Elevated Liver Function ... Tests (LFTs) - ... Cirrhosis • Chronic ... injury) • Ischemic ... Function #Tests #LFTs
The Liver Consult Primer - Guide to calling a consult
HPI:
 - Start with reason for consult
- Vitals - LFTs ... current MELD - Chronic ... liver disease work ... up - Liver US ... Referral #Hepatology #Gastroenterology
Hepatocellular Liver Injury - Differential Diagnosis Framework:
Liver Injury → liver test abnormalities without evidence of liver
Injuryliver ... Hemochromatosis, Wilson's disease ... HELLP, Celiac disease ... Diagnosis #hepatology #algorithm ... Transaminitis #LFTs
Acute-on-Chronic Liver Failure (ACLF) Clinical Guidelines

ACLF = possibly reversible condition in those with CLD (± cirrhosis)
Acute-on-Chronic ... disease, liver ... Injury (DILI) ... #ACLF #Acute #Chronic ... Cirrhosis #Hepatology #gastroenterology
Liver Chemistries - Interpretation of LFTs

R-value: Serum (ALT/ULN ALT) / (Alk phos/ULN ALP)
 • R >
Interpretation of LFTs ... disease: > 2 ... • NASH, Chronic ... : > 3 • Chronic ... transaminitis #LFTs
Acute Liver Injury - Differential Diagnosis Algorithm

Vascular Causes of Acute Liver Injury: 
 • Hepatic vein:
Acute Liver Injury ... Differential Diagnosis Algorithm ... • NASH, Chronic ... : > 3 • Chronic ... differential #diagnosis #algorithm
Diagnostic algorithm for a child or adolescent with suspected pulmonary hypertension. CHD, congenital heart disease; CPET,
Diagnostic algorithm ... testing; CTEPH, chronic ... dysplasia; CLD, chronic ... lung disease; LFT ... , liver function
Anemia - Underproduction Diagnostic Algorithm
 - Iron deficiency anemia
 - Anemia of chronic inflammation
 - Anemia
Underproduction Diagnostic Algorithm ... - Anemia of chronic ... - Anemia of chronic ... kidney disease ... disorder - TSH, LFTs
Drug Induced Liver Injury (DILI) - Stepwise Diagnosis Algorithm
DILI suspicion
Features toxic aetiology: Skin involvement, Kidney injury,
Stepwise Diagnosis Algorithm ... disease, Hepatic ... dechallenge • Acute or chronic ... e.g. ascites), Chronic ... #Algorithm #hepatology