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

DILI Types:
 • Intrinsic - predictable, dose dependent
Chronic - ongoing ↑ LFTs ... or symptoms of liver ... Drug #induced #Liver ... gastroenterology #algorithm ... gastroenterology #hepatology
Drug-Induced Liver Injury - Pathophysiology
Indirect
Idiosyncratic
Direct

BWH Medicine Chiefs @BrighamChiefs

#DILI #DrugInduced #Liver #Injury #Pathophysiology #hepatology
Drug-Induced Liver ... Injury - Pathophysiology ... BrighamChiefs #DILI ... #DrugInduced #Liver ... #hepatology
Elevated Liver Function Tests (LFTs) - Differential Diagnosis Framework
Mild (<100-500): 
 • NAFLD
 • Cirrhosis
 •
Elevated Liver Function ... Tests (LFTs) - ... (>1000): • DILI ... Function #Tests #LFTs ... Differential #Diagnosis #hepatology
Drug Induced Liver Injury (DILI) - Stepwise Diagnosis Algorithm
DILI suspicion
Features toxic aetiology: Skin involvement, Kidney injury,
Injury (DILI) - ... Stepwise Diagnosis Algorithm ... non-essential drug/HDS treatments ... Injury #Diagnosis #Algorithm ... #hepatology
Anemia - Underproduction Diagnostic Algorithm
 - Iron deficiency anemia
 - Anemia of chronic inflammation
 - Anemia
Anemia - Underproduction ... Diagnostic Algorithm ... disorder - TSH, LFTs ... Underproduction #Algorithm ... #hematology #diagnosis
Liver Function Test (LFTs) Elevation
AST - Cardiac and skeletal muscle, kidney, brain
ALT - More specific for
Liver Function Test ... (LFTs) Elevation ... abnormality vs bone Bili ... #FunctionTest #LFTs ... Transaminitis #diagnosis #hepatology
Evaluation abnormal liver tests in pregnancy
- Cholestatic Pattern
- Hepatocellular Pattern

#LFTs #transaminits #pregnancy #obgyn #obstetrics #hepatology #diagnosis
Evaluation abnormal liver ... Hepatocellular Pattern #LFTs ... obgyn #obstetrics #hepatology ... #differential #algorithm
The Liver Consult Primer - Guide to calling a consult
HPI:
 - Start with reason for consult
Focus on prior Liver ... - Vitals - LFTs ... GTT, indirect bili ... US - Prior liver ... Calling #Referral #Hepatology
Approach to Hypoproliferative Macrocytic Anemia

 • 812, Folate Deficiency
 • MDS+
 • Hypothyroid
 • Liver Disease
Hypoproliferative Macrocytic Anemia ... Hypothyroid • Liver ... #Macrocytic #Anemia ... differential #diagnosis #algorithm ... #hematology #workup
Acute-on-Chronic Liver Failure (ACLF) Clinical Guidelines

ACLF = possibly reversible condition in those with CLD (± cirrhosis)
Acute-on-Chronic Liver ... months without treatment ... disease, liver ... Injury (DILI) ... Failure #Cirrhosis #Hepatology