Patients often present with fever, abdominal pain, and jaundice. Multiple serum lab values are often elevated, including AST, ALT, and GGT. [radiopaedia.org]

It might be expected that the more severe cases presenting during the study period would not have been biopsied due to the presence of coagulopathy. [gut.bmj.com]

Younger patients present most commonly with a hepatocellular pattern of injury, whereas older patients mostly present with a cholestatic pattern of liver injury. 3 Some studies have found that women have a greater risk of developing DILI than men. 13 [mdedge.com]

Always consider drugs as a cause of any patient presenting with hepatitis in order to provide early effective management. [patient.info]

We present a 26-year-old male bodybuilder who self-administered high doses of androgenic/anabolic steroids that induced liver damage. [ncbi.nlm.nih.gov]

• Fever

  More common in children Cholestatic type Idiosyncratic reaction Nausea, vomiting, fever, RUQ pain, jaundice, leukocytosis, elevated aminotransferases Clinical improvement upon drug withdrawal No evidence of CLD on follow up 19. [slideshare.net]

  If fever, rash, or pruritis occurs from any medication, its use should be stopped immediately. [hepatitiscentral.com]

  A rash or fever may be part of some drug reactions that affect the liver. Treatment The only specific treatment for most cases of liver damage caused by taking a drug is to stop the drug that caused the problem. [m.ufhealth.org]

  These include: Pain and fever medicines that have acetaminophen Aspirin and over-the-counter pain and fever medicines (NSAIDs or nonsteroidal anti-inflammatory medicines) Anabolic steroids, man-made medicines that are like the male sex hormone testosterone [hopkinsmedicine.org]

  Other viral infections - eg, glandular fever, cytomegalovirus, HIV infection. Autoimmune hepatitis. Wilson's disease, haemochromatosis. Toxins - eg, alcoholic liver disease. [patient.info]

• Malaise

  Initially, anorexia, nausea, and malaise may occur, followed by pruritus in some but not all patients. [clinicalgate.com]

  These incidents usually occur during the first 6 months of treatment and are preceded by nonspecific symptoms such as malaise, weakness, lethargy, facial edema, anorexia, vomiting, and even loss of seizure control. [emedicine.medscape.com]

• Jaundice

  Combination of estrogenic and progestational steroids; estrogen is primarily responsible Intrahepatic cholestasis Pruritus and jaundice Susceptible patients: idiopathic jaundice of pregnancy, family history Focal nodular hyperplasia, adenomas 20. [slideshare.net]

  Such sensitization would have been evident during the second postoperative week, with such manifestations as fever, rash, eosinophilia, arthralgia, or jaundice. [hepatitiscentral.com]

  Viral hepatitis Acute hepatitis with jaundice can be the onset manifestation of acute viral hepatitis. [nature.com]

  In addition to the elevation of ALT and AST levels, cases of liver necrosis, jaundice, and fulminant hepatitis with and without jaundice have occurred. [emedicine.medscape.com]

  Others may have Loss of appetite Nausea and vomiting Diarrhea Dark-colored urine and pale bowel movements Stomach pain Jaundice, yellowing of skin and eyes Some forms of hepatitis are mild, and others can be serious. [icdlist.com]

• Recurrent Jaundice

  Oral contraceptives are contraindicated in patients with a history of recurrent jaundice of pregnancy. [scialert.net]

  Patients with recurrent idiopathic jaundice of pregnancy, severe pruritus of pregnancy, or a family history of these disorders are more susceptible to hepatic injury. [emedicine.medscape.com]

• Scleral Icterus

  Patient 1 On July 16, 1992, a 42-year-old man visited his family physician for evaluation of scleral icterus and diffuse jaundice. [cdc.gov]

• Dark Urine

  Later, there may be jaundice and dark urine and an enlarged and tender liver. When the offending medication is withdrawn, symptoms may gradually subside. Reactions may be severe, however, and even fatal, even though the medication is stopped. [hepatitiscentral.com]

  Some of the common symptoms are: nausea vomiting headache anorexia jaundice clay color stools dark urine hepatomegaly Diagnosis Diagnosis is typically made through a physical exam along with a patient history to identify any possible hepatotoxins. [medical-dictionary.thefreedictionary.com]

  urine Diarrhea Fatigue Fever Headache Jaundice Loss of appetite Nausea and vomiting Rash White or clay-colored stools Exams and Tests You will have blood tests to check liver function. [m.ufhealth.org]

  Symptoms may include: Belly pain Tiredness and weakness Fever Nausea Vomiting Lack of appetite Dark urine Pale or clay-colored stools Yellowing of the skin and eyes (jaundice) The symptoms of drug-induced hepatitis may look like other health problems. [hopkinsmedicine.org]

[…] cardiovascular causes, especially right-sided heart failure Cholecystitis Cholangitis Budd-Chiari syndrome Alcoholic liver disease Cholestatic liver disease Pregnancy-related conditions of liver Malignancy Wilson disease Hemochromatosis Coagulation disorders Workup [emedicine.medscape.com]

Complementary and alternative therapies in the treatment of chronic hepatitis C: a systematic review. J Hepatol. 2004;40(3):491-500. 7. Sherman KE, Sjogren M, et al. [passeportsante.net]

The main treatment for DILI is withdrawal of the offending drug [medicscientist.com]

Reichen J: Treatment of cholestasis. Semin Liv Dis 13:302–315, 1993 Google Scholar 23. [link.springer.com]

Treatment There is no specific treatment for non-alcoholic fatty liver disease. [labtestsonline.org]

Obtaining a history of exposure to hepatotoxic chemicals, medications, or other agents assists in early initiation of treatment and removal of the offending agent. [hepatitiscentral.com]

What is the Prognosis of Drug-Induced Hepatitis? (Outcomes/Resolutions) The prognosis of Drug-Induced Hepatitis is usually good. [dovemed.com]

Treatment and prognosis Treatment depends on the etiology of the acute hepatitis. [radiopaedia.org]

Prognosis is good. Notice the presence of fine yellow granular bile pigment in the cytoplasm of hepatocytes around the central vein (zone 3). [meddean.luc.edu]

Prognosis Usually the symptoms will go away after the drug has been eliminated due to the liver repairing itself. A full recovery is typically expected unless it wasn't treated quickly resulting in more liver damage being done than normal. [medical-dictionary.thefreedictionary.com]

JCO. 2002, 20:2789-2797 Mavros MN, Mayo SC, Hyder O, Pawlik TM A systematic review treatment and prognosis of patients with fibrolamellar hepatocellular carcinoma. [ivyunion.org]

Etiologies may include: viral hepatitides: (e.g. [radiopaedia.org]

[…] drug exposure varies from hours to months Clinical manifestations range from asymptomatic deranged liver function to fulminant hepatic failure and death Mimic all forms of acute, chronic, vascular or neoplastic liver diseases that are caused by other etiologies [pathologyoutlines.com]

This categorization allows testing for competing etiologies in a systematic approach. [gi.org]

Keywords Primary Biliary Cirrhosis Autoimmune Hepatitis Reference Interval Antimitochondrial Antibody Histocompatibility Leukocyte Antigen Introduction The etiology of autoimmune hepatitis (AIH) is unknown. [jmedicalcasereports.biomedcentral.com]

(Etiology) Drug-Induced Hepatitis is caused by certain types of drugs, which include: Amiodarone Anabolic steroids Birth control pills Erythromycin General anesthetic halothane Methotrexate Sulfa antibiotics The exact mechanism of how these drugs lead [dovemed.com]

Hepatotoxicity of Herbals and Dietary Supplements Introduction Epidemiology of and Expenditure on Herbals and Dietary Supplements Origin and Production of Herbals and Botanicals for Medicinal Purposes Regulation of Dietary Supplements The Use of Herbal [elsevier.com]

About 10% of cases are idiosyncratic. [ 1 ] Epidemiology A very large number of drugs have been implicated as a potential cause of drug-induced hepatitis but with variable risk of both frequency and severity. [patient.info]

This case report intends to draw the attention of clinicians and patients to the importance of recognizing any possible signs of cutaneous adverse reactions during nimesulide therapy, although only extensive epidemiological data can define the real impact [jpgmonline.com]

Epidemiology and individual susceptibility to adverse drug reactions affecting the liver. Seminars Liver Dis., 22: 145-155. PubMed | Lee, W.M. and W.T. Denton, 1989. [scialert.net]

Epidemiology of idiosyncratic drug-induced liver injury. Semin Liver Dis. 2009;29:337-347. 5. Larson AM. Drug-induced liver injury. UptoDate. www.uptodate.com/contents/drug-induced-liver-injury. Accessed July 8, 2016. 6. [uspharmacist.com]

Definition / general Drug / toxin reactions can be intrinsic or predictable, where they are dose dependent (e.g. acetaminophen ); or idiosyncratic and unpredictable, where they are dose independent (e.g. isoniazid) Pathophysiology Underlying mechanisms [pathologyoutlines.com]

The latter are unpredictable and dose-independent and may be related to either toxic or autoimmune pathophysiology. [karger.com]

[…] and mechanisms of drug-induced liver injury Pathophysiologic mechanisms The pathophysiologic mechanisms of hepatotoxicity are still being explored and include both hepatocellular and extracellular mechanisms. [emedicine.medscape.com]

Oxidant Stress, Antioxidant Defense, and Liver Injury Introduction The Major Reactive Oxygen and Nitrogen Species in the Liver and their Sources Pathophysiological Consequences of Oxidative Stress Antioxidants Drug-Induced Oxidative Stress in the Liver [elsevier.com]

Review article: drug-induced liver injury—its pathophysiology and evolving diagnostic tools. Aliment Pharmacol Ther. 2011;34:11-20. 36. Roy PK. Budd-Chiari syndrome. Medscape. http://emedicine.medscape.com/article/184430-overview. [uspharmacist.com]

To prevent hepatitis D: Since the hepatitis D virus cannot infect on its own without hepatitis B, use the preventive measures outlined in hepatitis B. To prevent hepatitis E, remember to: Wash hands well after using any washroom. [healthcentral.com]

Centers for Disease Control and Prevention, Health Topics, Viral hepatitis, Brochures – Prevent Hepatitis A, CDC. [Consulté le 11 août 2011]. www.cdc.gov 6. Coon JT, Ernst E. [passeportsante.net]

There is no vaccine available to prevent hepatitis C, but research is in progress to develop one. [labtestsonline.org]

Supportive measures Gastric lavage Activated charcoal or cholestyramine (prevent absorption); should be given within 30 mins N-acetylcysteine given within 8 hrs; loading dose-140/kg, ff by 70mg/kg q 4 hrs x 15-20 doses Survivors have no evidence of hepatic [slideshare.net]

Monitoring for and recognition of drug-induced hepatotoxicity may prevent some cases of acute hepatic failure. [nejm.org]