Drug Induced Liver Injury (DILI) - Stepwise Diagnosis Algorithm DILI suspicion Features toxic aetiology: Skin involvement, Kidney injury, Previous DILI episodes Careful enquiry of exposure to HDS, drugs, OTC (record start and stop dates) Potential pitfalls: Lack of information (e.g. dose, duration), Several medications, Hidden OTC and HDS intake Discontinue any non-essential drug/HDS treatments Search in hepatotoxicity resources (Liver tox) Search for alternative causes • Hepatocellular: Viral infections (HAV, HBV, HCV, HEV, EBV, CMV), Alcohol-related liver disease, Hepatic ischaemia, Autoantibody titres, ↑ IgG • Cholestatic: Benign/malignant biliary obstruction, Primary biliary cholangitis, Primary sclerosing cholangitis Consider liver biopsy if: • Negative or incomplete dechallenge • Acute or chronic atypical presentation: Hepatic vascular disorder (e.g. ascites), Chronic hepatitis fibrosis • Microvesicular steatosis • Autoimmune hepatitis #DILI #DrugInduced #Liver #Injury #Diagnosis #Algorithm #hepatology
