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Liver Disorders pp 389–403Cite as

Drug-Induced Liver Injury

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Abstract

The central role of the liver in the process of metabolism and detoxification unfortunately places it at a disproportionate risk for drug- or toxin-induced injury. Individuals with liver injury resulting from damage to hepatocytes (hepatocellular) or biliary tree (cholestatic) or both (cholestatic hepatitis or mixed) develop abnormalities in liver tests, and clinical presentation may vary from asymptomatic lab abnormalities to symptoms such as upper abdominal pain, jaundice, acholic stools, darkening of urine, and other constitutional symptoms. Drug-induced liver injury (DILI) can mimic almost all known liver diseases and is therefore almost always a diagnosis of exclusion. DILI may be broadly classified as intrinsic, that is predictable and dose-dependent or idiosyncratic hepatotoxicity that is rare and not necessarily dose dependent. Idiosyncratic DILI from any one drug is a rare and a largely unpredictable event causing hepatic damage at therapeutic concentrations and causing nonzonal necrosis. Mechanisms of injury are usually immunogenic or host susceptibility from genetic or acquired inability to detoxify hepatotoxic drug intermediates. A high index of suspicion, a thorough medication history that particular attention to herbal and dietary supplement use is necessary for a timely diagnosis. Use of web-based resources such as www.livertox.nih.gov is highly recommended for use as an aid for health care providers to make a diagnosis of DILI.

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Author information

Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, Indiana University School of Medicine, 702 Rotary Building, Suite 225, Indianapolis, IN, 46202, USA

    Raj Vuppalanchi M.D.

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  1. Raj Vuppalanchi M.D.
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Correspondence to Raj Vuppalanchi M.D. .

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Editors and Affiliations

  1. Division of Gastroenterology and Hepatology, Medical College of Wisconsin , Milwaukee, Wisconsin, USA

    Kia Saeian

  2. Division of Gastroenterology and Hepatology, Medicine Medical College of Wisconsin , Milwaukee, Wisconsin, USA

    Reza Shaker

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Vuppalanchi, R. (2017). Drug-Induced Liver Injury. In: Saeian, K., Shaker, R. (eds) Liver Disorders. Springer, Cham. https://doi.org/10.1007/978-3-319-30103-7_25

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  • DOI: https://doi.org/10.1007/978-3-319-30103-7_25

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