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Drug-Induced Liver Injury

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Liver Disease in Clinical Practice

Part of the book series: In Clinical Practice ((ICP))

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Abstract

Idiosyncratic drug-induced liver injury (DILI) is an acute liver injury that occurs in individuals taking a medication at its therapeutic dose. Its latency period ranges from days to months, and it is the second most common aetiology of acute admissions with jaundice after ruling out biliary obstruction. A combination of drug-specific and host-related factors are involved in its pathogenesis, with a significant role of the human leukocyte system (HLA) in increasing the susceptibility to liver injury from multiple drugs. Although the thresholds to define acute DILI, its patterns and severity were standardised in 2011, the clinical diagnosis of DILI remains challenging, with the first step being the clinical suspicion in any acute liver injury and withdrawing the suspected drug. Systematic evaluation is necessary to reach a confident diagnosis of DILI. Liver biopsy and genetic tests are useful adjuncts in certain cases to guide clinical management. Acute hepatocellular injury with jaundice is associated with the worst prognosis and warrants transfer to a specialist centre in the event of no improvement after drug withdrawal due to the high risk of acute liver failure. There is no evidence-based treatment for DILI; empirical use of steroids is not recommended except in cases when autoimmune hepatitis is suspected and in severe liver injury secondary to checkpoint inhibitors.

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Correspondence to Guruprasad P. Aithal .

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Atallah, E., Aithal, G.P. (2022). Drug-Induced Liver Injury. In: Cross, T. (eds) Liver Disease in Clinical Practice. In Clinical Practice. Springer, Cham. https://doi.org/10.1007/978-3-031-10012-3_3

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  • DOI: https://doi.org/10.1007/978-3-031-10012-3_3

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-10011-6

  • Online ISBN: 978-3-031-10012-3

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