Differential Diagnosis of drug induced liver disease.pptx

The differential diagnosis of drug-induced liver disease involves distinguishing it from other liver conditions by reviewing the patient’s medication history, symptoms, and lab results. It includes assessing liver function tests and imaging, and may require a liver biopsy. Accurate diagnosis is essential for effective treatment and management.

1. Differential Diagnosis of drug induced liver disease 2020031025100 15

2. Thorough Patient History: Obtain a detailed patient history, including recent medication changes, herbal supplements , and over-the-counter drugs. Inquire about alcohol consumption and any history of viral hepatitis .

3. Clinical Presentation: DILD can manifest with a range of symptoms, such as jaundice , abdominal pain, nausea, and fatigue. However, these symptoms can be non-specific and overlap with other liver disorders.

4. Laboratory Tests Liver function tests (LFTs) are crucial. Look for elevations in serum aminotransferases (ALT, AST), alkaline phosphatase , and bilirubin . Monitor for eosinophilia , which may be indicative of a hypersensitivity reaction

5. Imaging Studies Consider imaging studies, such as ultrasound or CT scan, to assess the liver's structure and rule out other liver diseases

6. Exclusion of Other Causes Rule out viral hepatitis (through serological tests), autoimmune liver diseases, Wilson's disease , and other metabolic liver disorders. Temporal Relationship with Drug Exposure Establish a temporal relationship between the initiation of a suspected drug and the onset of liver injury. The Naranjo Adverse Drug Reaction Probability Scale can be a useful tool.

7. Liver Biopsy (if needed): i n some cases, a liver biopsy may be necessary for a definitive diagnosis, especially if the cause is unclear or if the patient's condition is severe Withdrawal of Suspected Drug If possible, discontinue the suspected causative drug and observe for improvements in liver function.

8. Consultation with Hepatologist Collaboration with a hepatologist may be beneficial for complex cases or when a liver biopsy is contemplated.

9. Reference. Textbooks: "Harrison's Principles of Internal Medicine" is a comprehensive resource that covers various aspects of medicine, including hepatology . "Goodman & Gilman's The Pharmacological Basis of Therapeutics" provides insights into the pharmacology of drugs and their effects on different organ systems. Clinical Guidelines: The American College of Gastroenterology (ACG) and the European Association for the Study of the Liver (EASL) often publish guidelines related to liver diseases, including drug-induced liver injury. Naranjo Adverse Drug Reaction Probability Scale: The original reference for the Naranjo Scale is: Naranjo CA, Busto U, Sellers EM, et al. A method for estimating the probability of adverse drug reactions. Clin Pharmacol Ther . 1981;30(2):239-245.