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Essentials of Diagnosis
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Can mimic viral hepatitis, biliary tract obstruction, or other types of liver disease
In any patient with liver disease, clinicians must inquire about the use of many therapeutic agents, including over-the-counter herbal or dietary supplements
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General Considerations
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DIRECT HEPATOTOXICITY
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INDIRECT HEPATOTOXICITY
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Refers to liver injury that results when use of a drug leads to exacerbation of preexisting liver disease
An example is a flare of HBV infection in the setting of immunosuppressive therapy for a nonhepatic autoimmune disease
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IDIOSYNCRATIC REACTIONS
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Reactions are sporadic, not dose-related, and occasionally are associated with fever and eosinophilia (including drug rash with eosinophilia and systemic symptoms [DRESS] syndrome)
May have genetic predisposition
Usually reversible with discontinuation of the offending agent
Risk factors for chronicity (> 1 year) are older age, dyslipidemia, and severe acute injury
Examples include
Cholesterol-lowering agents, including statins
May cause serum aminotransferase elevations
Rarely cause true hepatitis and even more rarely cause acute liver failure
No longer considered contraindicated in patients with liver disease
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Noninflammatory (cholestasis alone):
Inflammatory (inflammation of portal areas with bile duct injury [cholangitis], often with allergic features such as eosinophilia):
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ACUTE OR CHRONIC HEPATITIS
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