Materiały źródłowe

• #1

  https://www.amerikanhastanesi.org/mayo-clinic-care-network/mayo-clinic-health-information-library/diseases-conditions/toxic-hepatitis

  Toxic hepatitis is an inflammation of your liver in reaction to certain substances to which you’re exposed. Toxic hepatitis can be caused by alcohol, chemicals, drugs or nutritional supplements. […] The symptoms of toxic hepatitis often go away when exposure to the toxin stops. But toxic hepatitis can permanently damage your liver, leading to irreversible scarring of liver tissue (cirrhosis) and in some cases to liver failure, which can be life-threatening. […] Tests and procedures used to diagnose toxic hepatitis include: Physical exam. Your doctor will likely perform a physical exam and take a medical history. Be sure to bring to your appointment all medications you’re taking, including over-the-counter drugs and herbs, in their original containers. […] Blood tests. Your doctor may order blood tests that look for high levels of certain liver enzymes. These enzyme levels can show how well your liver is functioning.

• #1 Toxic Hepatitis | Health & Human Services

  https://hhs.iowa.gov/epi-manual-guide-surveillance-investigation-and-reporting/environmental-disease/toxic-hepatitis

  Toxic hepatitis is any acute or sub-acute necrosis of the liver or other unspecified chemical hepatitis caused by exposure to non-medicinal toxic agents other than ethyl alcohol, including, but not limited to, carbon tetrachloride, chloroform, tetrachloroethane, trichloroethylene, phosphorus, TNT, chloronapthalenes, methylenedianilines, ethylene dibromide, and organic solvents. This includes ICD-9 codes 572.2 and 573.3 or ICD-10 codes K71.0 to K71.9. […] Diagnosis of toxic hepatitis caused by chemical exposure requires a thorough assessment of the patient, including clinical signs and symptoms, laboratory testing, an exposure history, and possible liver imaging and biopsy. Some of these tests are used to rule out other types of hepatitis. […] If a person is suspected of having, or has been diagnosed with toxic hepatitis, exposure to the chemical or drug(s) identified as the possible causative agent should be immediately discontinued.

• #1 Toxic hepatitis | ABC Medical Center

  https://centromedicoabc.com/en/padecimientos/toxic-hepatitis/

  Toxic hepatitis usually appears shortly after exposure to the toxin (hours or days), but in other cases, the reaction may gradually develop over weeks or months until the first symptoms appear. […] Once the doctor analyzes your symptoms and medical history, they will perform a physical examination and ask you if you have been taking medications, dietary supplements, or herbal remedies, or if you have been exposed to chemicals. […] They will also request imaging studies to confirm the diagnosis, such as: Blood tests, MRI, Computed tomography, Ultrasound, Elastography, Liver tissue biopsy. […] The treatment to be followed will be established once the cause of hepatitis is determined and the injury produced is known, which consists of suspending intake or exposure to the toxic substance and prescribing medications to regenerate the liver and reverse the damage. […] If there are serious symptoms, you will need to receive treatment in a hospital to eliminate the toxic substance as soon as possible. […] When there is serious irreversible damage that causes severe liver failure, the only therapeutic option will be a liver transplant.

• #1 Clinical Course and Diagnosis of Drug Induced Liver Disease – LiverTox – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK548733/

  The clinical symptoms, signs and patterns of liver test abnormalities of drug induced liver injury can mimic virtually any form of liver disease from acute viral hepatitis to gall stone disease with biliary obstruction, acute fatty liver and even chronic hepatitis and cirrhosis. […] There are no specific findings or laboratory tests that definitely prove that a suspected drug, nutritional supplement or herbal product is the cause of the injury. Drug induced liver injury is a diagnosis of exclusion and relies upon clinical judgment and knowledge about the potential of the agent to cause liver injury versus the likelihood that other forms of liver diseases are the cause. […] In judging the likelihood of drug induced liver disease, six features are important: the onset after starting the drug: time to onset [latency], the recovery after stopping the drug: time to recovery [challenge], the clinical pattern: injury pattern and clinical phenotype [phenotype], exclusion of other causes of liver injury [differential diagnosis], whether the drug is a known cause of liver injury [likelihood], response to reexposure, whether inadvertent or intentional [rechallenge].

• #1 Toxic hepatitis in occupational exposure to solvents

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3374978/

  Three conditions must be fulfilled for the diagnosis of professional toxic hepatitis: (1) Liver damage should take place after occupational exposure to a substance; patient occupational history and the workplace in question is necessary; (2) Liver enzymes must increase to at least double the upper limit of normal levels; and (3) Tertiary conditions, such as other causes of liver disease, must be excluded. […] Clinical presentation of occupational liver disease may be acute/subacute or chronic, but is often insidious. […] Signs and symptoms of toxic hepatitis occurring may include: jaundice, itching, and abdominal pain in the upper right portion of the abdomen, fatigue, loss of appetite, nausea and vomiting, rash, weight loss, and dark or tea-color urine. […] In acute toxic hepatitis the patients condition is similar to viral hepatitis and rapidly deteriorates, resulting in marked liver dysfunction, encephalopathy and coagulopathy.

• #1 Toxic Hepatitis | UCSF Department of Surgery

  https://surgery.ucsf.edu/condition/toxic-hepatitis

  In making a diagnosis of toxic hepatitis, your doctor will ask about your medical history, including detailed information regarding your medications, use of herbs or other over-the-counter nutritional supplements and alcohol consumption. Your doctor also will carry out a thorough physical exam, which can be helpful in determining the presence or absence of significant chronic liver disease. […] The following tests may be performed to assess the presence and severity of liver damage: […] Liver Function Tests – These include a series of special blood tests than can help determine if the liver is functioning properly. These tests also can assist in determining the extent and type of liver damage. […] Ultrasound – An ultrasound uses high-frequency sound waves to create images of organs and systems within your body. An ultrasound may be performed to generate detailed pictures of your liver.

• #1 Alcoholic hepatitis: Clinical manifestations and diagnosis – UpToDate

  https://www.uptodate.com/contents/alcoholic-hepatitis-clinical-manifestations-and-diagnosis

  Alcoholic hepatitis: Clinical manifestations and diagnosis […] This topic will review the clinical manifestations and diagnosis of alcoholic hepatitis. […] Obtaining an accurate history of alcohol use from a patient with suspected alcoholic hepatitis may be difficult. Questioning the patient’s family in private, after receiving permission from the patient to discuss his or her care with family members, may help elicit important information about the patient’s alcohol use. It is also absolutely essential that health care providers take a careful alcohol history, supplemented by use of either the CAGE or AUDIT questionnaires to establish the likelihood of problem alcohol drinking or abuse.

• #1 Liver Function Tests: Types, Purpose & Results Interpretation

  https://my.clevelandclinic.org/health/diagnostics/17662-liver-function-tests

  Elevated AST and ALT levels may indicate liver injury. These are the enzymes that are most commonly released into your bloodstream when your liver is stressed. […] What can a liver function test diagnose? […] Possible diagnoses may include: […] Toxic hepatitis. […] A liver function test is one of the simplest ways you and your healthcare provider can check on your liver. Whether theyre looking for liver disease or they just want to test the effects of a medication or treatment, it only takes a small sample of your blood to yield a lot of information. […] Liver function tests may not provide enough information in themselves to make a diagnosis.

• #1 Hepatotoxicity – Wikipedia

  https://en.wikipedia.org/wiki/Hepatotoxicity

  An elevation in serum bilirubin level of more than 2 times ULN with associated transaminase rise is an ominous sign. This indicates severe hepatotoxicity and is likely to lead to mortality in 10% to 15% of patients, especially if the offending drug is not stopped (Hy’s Law). This is because it requires significant damage to the liver to impair bilirubin excretion, hence minor impairment (in the absence of biliary obstruction or Gilbert syndrome) would not lead to jaundice. Other poor predictors of outcome are old age, female sex, high AST.

• #1 Toxic hepatitis in occupational exposure to solvents

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3374978/

  As a general rule, clinically significant liver injury is often defined as ALT 3 times the upper limit of normal (ULN). […] The measurement of total bile acids in serum may be a more sensitive indicator of hepatic function and has the advantage of being organ specific. […] Evaluation of the concentration of bile acids is not widely used as a routine screening test. […] The diagnosis of cirrhosis of the liver requires a histological demonstration for the evaluation of abnormal nodules of regeneration and fibrosis.

• #1 Toxic Hepatitis | UCSF Department of Surgery

  https://surgery.ucsf.edu/condition/toxic-hepatitis

  Computed Tomography (CT) – Your doctor also may suggest a computed tomography scan, also known as a CT scan, to obtain two-dimensional images of your liver. CT is an X-Ray technique that produces more detailed images of your internal organs than conventional X-Ray exams. This technology uses an X-Ray sensing unit, which rotates around your body, and a large computer to create cross-sectional images of the inside of your body. […] Liver Biopsy – A biopsy may be performed following blood tests and X-Rays if questions still exist about the nature and severity of your liver problem. During a biopsy, a small sample of tissue is removed from your liver using a thin needle. The tissue is prepared and stained in a laboratory for examination under a microscope.

• #1 Toxic hepatitis in occupational exposure to solvents

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3374978/

  The diagnosis of toxic hepatitis improves with the use of imaging techniques (ultrasound, contrast enhanced ultrasonography, computed tomography, magnetic resonance imaging). […] Mild forms of toxic hepatitis may not cause any symptoms and may be detected only by blood tests. […] Histological samples obtained from workers exposed to solvents that had only mild biochemical abnormalities have shown prominent fatty change, or steatosis, with degrees of inflammation and fibrosis, which suggest that parenchymal changes may be an early feature of solvent induced liver injury. […] The evaluation of plasma enzyme showed the advantage of being in the past been well tested in clinical practice, but the main disadvantage is that the enzymes are not organ specific and this can cause occasional diagnostic problems in clinical practice.

• #1 Toxic hepatitis // Middlesex Health

  https://middlesexhealth.org/learning-center/diseases-and-conditions/toxic-hepatitis

  Tests and procedures used to diagnose toxic hepatitis include: […] Your doctor may order blood tests that look for high levels of certain liver enzymes. These enzyme levels can show how well your liver is functioning. […] A liver biopsy can help confirm the diagnosis of toxic hepatitis and help exclude other causes. During a liver biopsy, a needle is used to extract a small sample of tissue from your liver. The sample is examined under a microscope.

• #1 Hepatotoxicity – Wikipedia

  https://en.wikipedia.org/wiki/Hepatotoxicity

  This remains a challenge in clinical practice due to a lack of reliable markers. Many other conditions lead to similar clinical as well as pathological pictures. To diagnose hepatotoxicity, a causal relationship between the use of the toxin or drug and subsequent liver damage has to be established, but might be difficult, especially when idiosyncratic reaction is suspected. Simultaneous use of multiple drugs may add to the complexity. As in acetaminophen toxicity, well established, dose-dependent, pharmacological hepatotoxicity is easier to spot. Several clinical scales such as CIOMS/RUCAM scale and Maria and Victorino criteria have been proposed to establish causal relationship between offending drug and liver damage. CIOMS/RUCAM scale involves a scoring system that categorizes the suspicion into „definite or highly probable” (score 8), „probable” (score 6-8), „possible” (score 3-5), „unlikely” (score 1-2) and „excluded” (score 0). In clinical practice, physicians put more emphasis on the presence or absence of similarity between the biochemical profile of the patient and known biochemical profile of the suspected toxicity (e.g., cholestatic damage in amoxycillin-clauvonic acid).

• #1 Drug-Induced Hepatotoxicity: Overview, Metabolism of Drugs, Clinical and Pathological Manifestations of Drug-Induced Liver Disease

  https://emedicine.medscape.com/article/169814-overview

  When a single agent is involved, the diagnosis may be relatively simple, but with multiple agents, implicating a specific agent as the cause is difficult. To facilitate the diagnosis of drug-induced hepatic injury, several clinical tools for causality assessment have been developed to assist the clinician. […] Physicians must be vigilant in identifying drug-related liver injury because early detection can decrease the severity of hepatotoxicity if the drug is discontinued. The manifestations of drug-induced hepatotoxicity are highly variable, ranging from asymptomatic elevation of liver enzymes to fulminant hepatic failure. Knowledge of the commonly implicated agents and a high index of suspicion are essential in diagnosis. […] A positive dechallenge is a 50% fall in serum transaminase levels within 8 days of stopping the drug. A positive dechallenge is very helpful in cases of use of multiple medications.

• #1 Special Considerations in Interpreting Liver Function Tests | AAFP

  https://www.aafp.org/pubs/afp/issues/1999/0415/p2223.html/1000

  Patients with cirrhosis often have normal or only slightly elevated serum AST and ALT levels. […] Various liver diseases are associated with typical ranges of AST and ALT levels. […] The highest ALT levels, often more than 10,000 U per L, are usually found in patients with acute toxic injury subsequent to, for example, acetaminophen overdose or acute ischemic insult to the liver. […] It is especially important to remember that in patients with acute alcoholic hepatitis, the serum AST level is almost never greater than 500 U per L and the serum ALT value is almost never greater than 300 U per L. […] Patients with alcoholic hepatitis can present with jaundice, abdominal pain, fever and a minimally elevated AST value, thereby leading to a misdiagnosis of cholecystitis. […] Cholestasis (lack of bile flow) results from the blockage of bile ducts or from a disease that impairs bile formation in the liver itself.

• #1 Evaluating Liver Test Abnormalities: Toxin-Induced Liver Injury

  https://www.hepatitis.va.gov/provider/courses/livertests/livertests-toxin-induced-liver-injury.asp?backto=provider/courses/livertests/livertests-16-01-01&backtext=Back%20to%20Marked%20Aminotransferase%20Elevation

  Most exogenous chemicals are processed by the liver. Similar to drug-induced liver injury, illicit drugs and toxins can cause either direct hepatotoxicity or idiosyncratic reactions. […] Detailed history is crucial in the diagnosis. Illicit drugs are often „cut” with various chemicals. Additionally, cocaine can cause acute hepatitis and a history of recent cocaine use should always be investigated in a patient with acute hepatitis. […] There are no specific signs for illicit drugs/toxin induced liver injury. Jaundice may be present. However, it is crucial to check for signs of potential liver synthetic dysfunction such as asterixis (encephalopathy) and ecchymosis (coagulopathy). […] Patients who develop encephalopathy (confusion/asterixis) should be urgently referred to a liver specialist or a transplant center.

• #1 Acetaminophen Toxicity: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/820200-overview

  The serum acetaminophen concentration is the basis for diagnosis and treatment. A diagnostic serum concentration is helpful, even in the absence of clinical symptoms, because clinical symptoms are delayed. The Rumack-Matthew nomogram interprets the acetaminophen concentration (in micrograms per milliliter), in relation to time (in hours) after ingestion, and predicts possible hepatotoxicity after single, acute ingestions of acetaminophen. […] Recommended serum studies are follows: Liver function tests (alanine aminotransferase [ALT], aspartate aminotransferase [AST]), bilirubin [total and fractionated], alkaline phosphatase) […] In patients with mental status changes, strongly consider serum ammonia levels and CT scanning of the brain. Laboratory findings in the phases of acetaminophen hepatotoxicity are as follows: Phase 1: Approximately 12 hours after an acute ingestion, liver function studies show a subclinical rise in serum transaminase concentrations (ALT, AST) […] Phase 2: Elevated serum ALT and AST, PT, and bilirubin concentration; renal function abnormalities may also be present and indicate nephrotoxicity […] Phase 3: Severe hepatotoxicity is evident on serum studies; hepatic centrilobular necrosis is diagnosed on liver biopsy.

• #1 Dimethylacetamide-induced occupational toxic hepatitis with a short term recurrence: a rare case report – Gong – Journal of Thoracic Disease

  https://jtd.amegroups.org/article/view/7499/html

  In recent years, N,N-dimethylacetamide (DMAc) is widely used in the textile and plastics industry as a solvent alternative to more toxic N,N-dimethylformamide (DMF). […] sporadic group case reports have revealed that DMAc could cause toxic hepatitis and symptoms or signs indicative of liver involvement among workers exposed to DMAc, with severe cases leading to death. […] Here, we report a case of hepatotoxicity due to DMAc exposure, who recovered after treatment but relapsed as soon as coming back to work. […] In summary, this case was tentatively diagnosed as DMAc-induced acute toxic hepatitis. […] Based on the occupational toxic liver disease diagnostic criteria (China GBZ 59-2010), the case was made a definite diagnosis as occupational acute toxic hepatitis induced by DMAc. […] To confirm a diagnosis of chemical induced toxic hepatitis, other forms of hepatitis and other disorders with similar symptoms should be ruled out.

• #1 Dimethylacetamide-induced occupational toxic hepatitis with a short term recurrence: a rare case report – Gong – Journal of Thoracic Disease

  https://jtd.amegroups.org/article/view/7499/html

  The diagnostic criteria are as follows: occupational exposure preceding liver damage; liver enzymes at least double the upper limit of normal level; and other causes of liver disease excluded. […] Notably, the tumor antigen AFP reached as high as 711.4 ng/mL in the early stage of his recurrence, which was far beyond the normal value of 20 ng/mL. […] Diagnostic criteria of occupational toxic hepatopathy (China GBZ 59-2010) has clarified DMAc as a common hepatotoxic agent. […] Therefore, it is important to focus on individual cases.

• #1 Drug-Induced Liver Injury: Twenty Five Cases of Acute Hepatitis Following Ingestion of Polygonum multiflorum Thunb

  https://www.gutnliver.org/journal/view.html?volume=5&number=4&spage=493

  Background/Aims: Complementary medicines, including herbal preparations and nutritional supplements, are widely used without prescriptions. As a result, there has been growing interest in the risk of hepatotoxicity with these agents. It is difficult to determine causal relationships between these herbal preparations and hepatotoxicity. We report on 25 patients diagnosed with toxic hepatitis following ingestion of Polygonum multiflorum Thunb. […] Drug induced liver injury (DILI) is an adverse drug reaction associated with commonly used drugs, mostly nonsteroidal anti-inflammatory drugs, paracetamol, and antimicrobial agents. In some reports, more than a 1,000 drugs of the modern pharmacopoeia can induce liver injury with different clinical presentations. Diagnosis of DILI is difficult and data on the incidence of DILI cases are extremely variable due to a lack of internationally accepted criteria of DILI. DILI associated with herbal preparations is not uncommon in Western and Asian societies. DILI caused by a single plant taken as a nutritional supplement has been occasionally reported.

• #1 A Case of Toxic Hepatitis by Weight-Loss Herbal Supplement Containing Garcinia cambogia

  https://jsms.sch.ac.kr/journal/view.php?number=281

  We report a case of patient with acute toxic hepatitis induced by weight-loss herbal supplement. […] The diagnosis of Wilsons disease based on clinical findings, biochemical tests, liver biopsy, and genetic studies has been reviewed recently and diagnostic algorithms using critical parameters have been suggested. […] Clinical presentations of toxic hepatitis are variable, so it is not possible to make a clear cut diagnosis as toxic hepatitis only by history of a medicine use. […] Thus differential diagnosis of toxic hepatitis is essential to rule out other liver disease and make a correct diagnosis. […] Laboratory tests for viral hepatitis, auto-immune disorders and various metabolic diseases should be performed in this context. […] The test results of the patient with toxic hepatitis can mimic other disease.

• #1 Toxic Hepatitis (Liver Toxicity): Symptoms, Causes & Treatments

  https://my.clevelandclinic.org/health/diseases/17915-toxic-hepatitis

  Toxic hepatitis treatment depends on the extent of damage to your liver, but you may be able to help your liver heal and/or protect the health of your liver by making lifestyle changes. […] Your healthcare provider talks with you about your symptoms and lifestyle. They also do a physical examination. Your provider may order tests to confirm a toxic hepatitis diagnosis. […] You may have certain blood tests such as: Comprehensive metabolic panel (CMP). Liver function tests. […] If your provider wants more information about your liver health, you may have: Imaging tests, such as CT scan or MRI. Liver biopsy. […] Toxic hepatitis treatment depends on the extent of damage to your liver. After checking your liver, your healthcare provider may recommend that you: Avoid taking certain medications or supplements that may cause liver toxicity. Stop drinking alcohol.

• #1 Evaluating Liver Test Abnormalities: Toxin-Induced Liver Injury

  https://www.hepatitis.va.gov/provider/courses/livertests/livertests-toxin-induced-liver-injury.asp?backto=provider/courses/livertests/livertests-16-01-01&backtext=Back%20to%20Marked%20Aminotransferase%20Elevation

  In acute hepatocellular injury, the presence of asterixis (encephalopathy) and coagulopathy defines acute liver failure. Patients should be urgently referred to liver specialists. […] Patients who develop coagulopathy (prolonged PT/INR) need to be monitored closely and should be urgently referred to liver specialists.

• #1 Drug-Induced Hepatotoxicity: Overview, Metabolism of Drugs, Clinical and Pathological Manifestations of Drug-Induced Liver Disease

  https://emedicine.medscape.com/article/169814-overview

  The prognosis is highly variable depending on the patient’s presentation and stage of liver damage. In a prospective study conducted in the United States from 1998-2001, the overall survival rate of patients (including those who received a liver transplant) was 72%. The outcome of acute liver failure is determined by etiology, the degree of hepatic encephalopathy present upon admission, and complications such as infections.

• #1 Toxic Hepatitis (Liver Toxicity): Symptoms, Causes & Treatments

  https://my.clevelandclinic.org/health/diseases/17915-toxic-hepatitis

  In many instances, toxic hepatitis is curable. Your liver can replace damaged cells over time, reversing the damage that occurred. […] Toxic hepatitis recovery time depends on: How long you’ve had the condition. The damage to your liver. […] Talk to your healthcare provider about your liver health. Follow your provider’s instructions for how to take care of yourself as you recover from toxic hepatitis.

• #1 Toxic Hepatitis: Symptoms, Causes, Treatment | Qwark

  https://qwarkhealth.com/conditions/toxic-hepatitis

  Toxic hepatitis is a condition that occurs when the liver becomes inflamed due to exposure to certain toxins, medications, or chemicals. […] Diagnosis often involves blood tests and imaging studies to evaluate liver function and rule out other conditions. […] Drug-induced toxic hepatitis can be identified through a combination of clinical signs, liver function tests, and the patient`s medical history. […] Toxic hepatitis is diagnosed through a combination of physical examination, patient history, and laboratory tests. […] The most commonly used lab tests for diagnosing toxic hepatitis include liver function tests, which evaluate the liver`s ability to perform its normal functions. […] Imaging tests like MRI and ultrasound are not typically used for diagnosing toxic hepatitis since they typically do not show any specific changes in the liver that are associated with the condition. […] Liver biopsy may be used to help diagnose toxic hepatitis in certain cases. […] Early detection of toxic hepatitis is crucial for improving the prognosis. Prompt diagnosis and treatment can prevent further damage to the liver and increase the chances of a full recovery.

• #2

  https://www.kuh.ku.edu.tr/mayo-clinic-care-network/mayo-clinic-health-information-library/diseases-conditions/toxic-hepatitis

  Toxic hepatitis is an inflammation of your liver in reaction to certain substances to which you’re exposed. Toxic hepatitis can be caused by alcohol, chemicals, drugs or nutritional supplements. […] Toxic hepatitis occurs when your liver develops inflammation because of exposure to a toxic substance. Toxic hepatitis may also develop when you take too much of a prescription or over-the-counter medication. […] Tests and procedures used to diagnose toxic hepatitis include: Physical exam. Your doctor will likely perform a physical exam and take a medical history. Be sure to bring to your appointment all medications you’re taking, including over-the-counter drugs and herbs, in their original containers. Tell your doctor if you work with industrial chemicals or may have been exposed to pesticides, herbicides or other environmental toxins. Blood tests. Your doctor may order blood tests that look for high levels of certain liver enzymes. These enzyme levels can show how well your liver is functioning. Imaging tests. Your doctor may recommend an imaging test to create a picture of your liver using ultrasound, computerized tomography (CT) or magnetic resonance imaging (MRI). Additional imaging tests may include magnetic elastography and transient elastography. Liver biopsy. A liver biopsy can help confirm the diagnosis of toxic hepatitis and help exclude other causes. During a liver biopsy, a needle is used to extract a small sample of tissue from your liver. The sample is examined under a microscope.

• #2 Toxic Hepatitis | Health & Human Services

  https://hhs.iowa.gov/epi-manual-guide-surveillance-investigation-and-reporting/environmental-disease/toxic-hepatitis

  All cases diagnosed as chemical hepatitis or toxic hepatitis are required to be reported, including prolonged or possible overexposure to non-medicinal toxic agents other than ethyl alcohol, including, but not limited to, carbon tetrachloride, chloroform, tetrachloroethane, trichloroethylene, phosphorus, TNT, chloronapthalenes, methylenedianilines, ethylene dibromide, and organic solvents (this includes ICD-9 codes 572.2 and 573.3 or ICD-10 codes K71.0 to K71.9).

• #2 Albendazole-induced granulomatous hepatitis: a case report | Journal of Medical Case Reports | Full Text

  https://jmedicalcasereports.biomedcentral.com/articles/10.1186/1752-1947-7-201

  Drug-related hepatotoxicity is a common medical problem with implications for health systems. The diagnosis of drug-induced liver injury is challenging; it is difficult to define the cause of drug hepatotoxicity due to the heterogeneity of the clinical presentation and the absence of established criteria for accurate and reproducible identification of drug-associated liver toxicity. […] In order for a drug to be responsible for granulomatous hepatitis and make a definitive diagnosis of drug-induced liver injury (DILI), it is necessary to exclude other causes and demonstrate the improvement of the condition after stopping the offending drug. […] There are no absolute criteria or specific method for the diagnosis of toxic hepatitis. The most widely used scale is the Council for International Organizations of Medical Sciences (CIOMS)-Roussel Uclaf Causality Assessment Method (RUCAM), developed in 1995, which relates a causative agent and toxic liver damage, and has the following results: highly probable, probable, possible, unlikely, or excluded, according to the total score.

• #2 Toxic hepatitis in occupational exposure to solvents

  https://www.wjgnet.com/1007-9327/full/v18/i22/2756.htm

  Some studies have suggested that exposure to organic solvents may induce liver toxicity because most chemicals are metabolized in the liver and toxic metabolites generated through the metabolism are the main cause of liver damage. […] Three conditions must be fulfilled for the diagnosis of professional toxic hepatitis: (1) Liver damage should take place after occupational exposure to a substance; patient occupational history and the workplace in question is necessary; (2) Liver enzymes must increase to at least double the upper limit of normal levels; and (3) Tertiary conditions, such as other causes of liver disease, must be excluded. […] The evaluation of plasma enzyme showed the advantage of being in the past been well tested in clinical practice, but the main disadvantage is that the enzymes are not organ specific and this can cause occasional diagnostic problems in clinical practice.

• #2 Toxic Hepatitis | Conditions | UCSF Health

  https://www.ucsfhealth.org/conditions/toxic-hepatitis

  UCSF offers the most advanced diagnostic and treatment options for patients with toxic hepatitis. […] In making a diagnosis of toxic hepatitis, your doctor will ask about your medical history, including detailed information regarding your medications, use of herbs or other over-the-counter nutritional supplements and alcohol consumption. Your doctor also will carry out a thorough physical exam, which can be helpful in determining the presence or absence of significant chronic liver disease. […] The following tests may be performed to assess the presence and severity of liver damage: […] Liver Function Tests These include a series of special blood tests than can help determine if the liver is functioning properly. These tests also can assist in determining the extent and type of liver damage.

• #2 Toxic hepatitis // Middlesex Health

  https://middlesexhealth.org/learning-center/diseases-and-conditions/toxic-hepatitis

  Tests and procedures used to diagnose toxic hepatitis include: […] Your doctor may order blood tests that look for high levels of certain liver enzymes. These enzyme levels can show how well your liver is functioning. […] A liver biopsy can help confirm the diagnosis of toxic hepatitis and help exclude other causes. During a liver biopsy, a needle is used to extract a small sample of tissue from your liver. The sample is examined under a microscope.

• #2 Toxic hepatitis in occupational exposure to solvents

  https://www.wjgnet.com/1007-9327/full/v18/i22/2756.htm

  As a general rule, clinically significant liver injury is often defined as ALT 3 times the upper limit of normal (ULN). […] The diagnosis of toxic hepatitis improves with the use of imaging techniques (ultrasound, contrast enhanced ultrasonography, computed tomography, magnetic resonance imaging). […] Toxic hepatitis is characterized by different degrees of steatosis and fibrosis, which can lead to cirrhosis. […] Chronic toxic hepatitis can progress to cirrhosis and liver failure.

• #2 Toxic Hepatitis | Conditions | UCSF Health

  https://www.ucsfhealth.org/conditions/toxic-hepatitis

  Ultrasound An ultrasound uses high-frequency sound waves to create images of organs and systems within your body. An ultrasound may be performed to generate detailed pictures of your liver. […] Computed Tomography (CT) Your doctor also may suggest a computed tomography scan, also known as a CT scan, to obtain two-dimensional images of your liver. CT is an X-Ray technique that produces more detailed images of your internal organs than conventional X-Ray exams. This technology uses an X-Ray sensing unit, which rotates around your body, and a large computer to create cross-sectional images of the inside of your body. […] Liver Biopsy A biopsy may be performed following blood tests and X-Rays if questions still exist about the nature and severity of your liver problem. During a biopsy, a small sample of tissue is removed from your liver using a thin needle. The tissue is prepared and stained in a laboratory for examination under a microscope.

• #2 Toxic Hepatitis: Symptoms, Causes, Treatment | Qwark

  https://qwarkhealth.com/conditions/toxic-hepatitis

  Toxic hepatitis is a condition that occurs when the liver becomes inflamed due to exposure to certain toxins, medications, or chemicals. […] Diagnosis often involves blood tests and imaging studies to evaluate liver function and rule out other conditions. […] Drug-induced toxic hepatitis can be identified through a combination of clinical signs, liver function tests, and the patient`s medical history. […] Toxic hepatitis is diagnosed through a combination of physical examination, patient history, and laboratory tests. […] The most commonly used lab tests for diagnosing toxic hepatitis include liver function tests, which evaluate the liver`s ability to perform its normal functions. […] Imaging tests like MRI and ultrasound are not typically used for diagnosing toxic hepatitis since they typically do not show any specific changes in the liver that are associated with the condition. […] Liver biopsy may be used to help diagnose toxic hepatitis in certain cases. […] Early detection of toxic hepatitis is crucial for improving the prognosis. Prompt diagnosis and treatment can prevent further damage to the liver and increase the chances of a full recovery.

• #2 Toxic hepatitis – Augusta HealthSearchClose SearchSearch IconSearch IconClose Search IconMobile Menu IconMobile Menu Close IconInstagramFacebookTwitterYoutube

  https://www.augustahealth.com/disease/toxic-hepatitis/

  Toxic hepatitis occurs when your liver develops inflammation because of exposure to a toxic substance. Toxic hepatitis may also develop when you take too much of a prescription or over-the-counter medication. […] Tests and procedures used to diagnose toxic hepatitis include: […] Your doctor will likely perform a physical exam and take a medical history. Be sure to bring to your appointment all medications you’re taking, including over-the-counter drugs and herbs, in their original containers. Tell your doctor if you work with industrial chemicals or may have been exposed to pesticides, herbicides or other environmental toxins. […] Your doctor may order blood tests that look for high levels of certain liver enzymes. These enzyme levels can show how well your liver is functioning. […] A liver biopsy can help confirm the diagnosis of toxic hepatitis and help exclude other causes. During a liver biopsy, a needle is used to extract a small sample of tissue from your liver. The sample is examined under a microscope.

• #2 Clinical Course and Diagnosis of Drug Induced Liver Disease – LiverTox – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK548733/

  The final important element in diagnosis of drug induced liver disease is exclusion of other diagnoses. […] The diagnosis of drug induced liver disease is made easier if they suspected agent is known to cause liver injury. […] Reexposure or rechallenge of a patient to a medication or agent thought to be responsible for drug induced liver injury is usually not advisable. […] Finally, it should be stressed that most cases of drug induced liver injury are complex and may be difficult to attribute to the suspect drug.

• #2 A Case of Toxic Hepatitis by Weight-Loss Herbal Supplement Containing Garcinia cambogia

  https://jsms.sch.ac.kr/journal/view.php?number=281

  A low serum ceruloplasmin level may make physicians consider the diagnosis of Wilsons disease. […] However, the ceruloplasmin level has limited practical use, because the ceruloplasmin concentrations under 20 mg/dL is able to be found in 1% of controls, in 10% of heterozygous Wilson disease carriers and in patients with copper deficiency, Menkes disease, hereditary hypoceruloplasminemia, malabsorption, nephrotic syndrome, and chronic liver failure. […] In short, hepatic copper concentration is expected to be elevated in cholestatic condition such as biliary atresia or other situation of hepatic congestion, since bile ducts are blocked and cholestasis persists. […] Our patients declined ceruloplasmin level might be due to her mal-nutrition in her effort of weight reduction. […] Her increased liver copper level could be attributable to cholestasis consistent with hepatotoxicity associated with dietary herbal supplement.

• #2 Toxic Hepatitis (Liver Toxicity): Symptoms, Causes & Treatments

  https://my.clevelandclinic.org/health/diseases/17915-toxic-hepatitis

  In many instances, toxic hepatitis is curable. Your liver can replace damaged cells over time, reversing the damage that occurred. […] Toxic hepatitis recovery time depends on: How long you’ve had the condition. The damage to your liver. […] Talk to your healthcare provider about your liver health. Follow your provider’s instructions for how to take care of yourself as you recover from toxic hepatitis.

• #2 Evaluating Liver Test Abnormalities: Toxin-Induced Liver Injury

  https://www.hepatitis.va.gov/provider/courses/livertests/livertests-toxin-induced-liver-injury.asp?backto=provider/courses/livertests/livertests-16-01-01&backtext=Back%20to%20Marked%20Aminotransferase%20Elevation

  In acute hepatocellular injury, the presence of asterixis (encephalopathy) and coagulopathy defines acute liver failure. Patients should be urgently referred to liver specialists. […] Patients who develop coagulopathy (prolonged PT/INR) need to be monitored closely and should be urgently referred to liver specialists.

• #3 Toxic Hepatitis Causes, Symptoms, Diagnosis and Treatment – Cura4U

  https://cura4u.com/conditions/toxic-hepatitis

  The following tests and procedures are used to diagnose toxic hepatitis: […] A physical exam and a medical history will most likely be taken by your doctor. […] Blood tests such as liver function test (ALT, AST, Alkaline Phosphatase (ALP), Bilirubin, Total proteins, GGT etc) to check for high levels of certain liver enzymes and various components may be ordered by your doctor. […] Your doctor may recommend imaging tests such as ultrasonography, computed tomography (CT scan), Magnetic resonance imaging (MRI) to obtain a clear picture of your liver. […] A liver biopsy can help confirm toxic hepatitis and rule out other causes.

• #3

  https://www.amerikanhastanesi.org/mayo-clinic-care-network/mayo-clinic-health-information-library/diseases-conditions/toxic-hepatitis

  Imaging tests. Your doctor may recommend an imaging test to create a picture of your liver using ultrasound, computerized tomography (CT) or magnetic resonance imaging (MRI). […] Liver biopsy. A liver biopsy can help confirm the diagnosis of toxic hepatitis and help exclude other causes. During a liver biopsy, a needle is used to extract a small sample of tissue from your liver. The sample is examined under a microscope.

• #3 Drug-Induced Hepatotoxicity: Overview, Metabolism of Drugs, Clinical and Pathological Manifestations of Drug-Induced Liver Disease

  https://emedicine.medscape.com/article/169814-overview

  When a single agent is involved, the diagnosis may be relatively simple, but with multiple agents, implicating a specific agent as the cause is difficult. To facilitate the diagnosis of drug-induced hepatic injury, several clinical tools for causality assessment have been developed to assist the clinician. […] Physicians must be vigilant in identifying drug-related liver injury because early detection can decrease the severity of hepatotoxicity if the drug is discontinued. The manifestations of drug-induced hepatotoxicity are highly variable, ranging from asymptomatic elevation of liver enzymes to fulminant hepatic failure. Knowledge of the commonly implicated agents and a high index of suspicion are essential in diagnosis. […] A positive dechallenge is a 50% fall in serum transaminase levels within 8 days of stopping the drug. A positive dechallenge is very helpful in cases of use of multiple medications.

• #3 Diagnosis and Management of Autoimmune Hepatitis: Current Status and Future Directions

  https://www.gutnliver.org/journal/view.html?doi=10.5009/gnl15352

  The diagnostic criteria of the IAIHG require the presence of compatible laboratory (serum aspartate [AST] and alanine aminotransferase [ALT] abnormalities, hypergammaglobulinemia, and increased serum IgG level), serological (ANA, SMA or anti-LKM1 positivity) and histological findings (interface hepatitis with or without plasma cell infiltration). Diseases that can resemble autoimmune hepatitis must also be excluded by appropriate tests, and these include virus-related, drug-induced, alcoholic, hereditary (Wilson disease, hereditary hemochromatosis), metabolic (nonalcoholic fatty liver disease [NAFLD]), and immune-mediated cholestatic diseases (PBC and PSC). […] The revised original scoring system is a comprehensive template that evaluates 13 clinical categories and renders 27 possible grades. This comprehensive scoring system was originally developed as a research tool by which to ensure the homogeneity of patient populations in clinical studies. It has emerged subsequently as a template by which to ensure the systematic evaluation of patients, and it can serve as a mechanism by which to bolster clinical judgment.

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