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Hepatic Injury from Toxins
Michael P. Federle, MD, FACR
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            • Diagnostic Checklist

              TERMINOLOGY

              • Definitions

                • Injury to liver induced by exogenous toxins, either through direct hepatotoxicity or idiosyncratic reaction

              IMAGING

              • General Features

                • CT Findings

                  • MR Findings

                    • Ultrasonographic Findings

                      • Imaging Recommendations

                        DIFFERENTIAL DIAGNOSIS

                          PATHOLOGY

                          • Staging, Grading, & Classification

                            • Microscopic Features

                              CLINICAL ISSUES

                              • Presentation

                                • Natural History & Prognosis

                                  • Treatment

                                    DIAGNOSTIC CHECKLIST

                                    • Image Interpretation Pearls

                                      Selected References

                                      1. Heard K et al: A single-arm clinical trial of a 48-hour intravenous N-acetylcysteine protocol for treatment of acetaminophen poisoning. Clin Toxicol (Phila). 52(5):512-8, 2014
                                      2. Corsini A et al: Drug-induced liver injury: the role of drug metabolism and transport. J Clin Pharmacol. 53(5):463-74, 2013
                                      3. Shah AD et al: Understanding lactic acidosis in paracetamol (acetaminophen) poisoning. Br J Clin Pharmacol. 71(1):20-8, 2011
                                      4. Ikeda T: Drug-induced idiosyncratic hepatotoxicity: prevention strategy developed after the troglitazone case. Drug Metab Pharmacokinet. 26(1):60-70, 2011
                                      5. Akman SA et al: Liver transplantation for acute liver failure due to toxic agent ingestion in children. Pediatr Transplant. 2009 Dec;13(8):1034-40. Epub 2009 Feb 6. Erratum in: Pediatr Transplant. 14(8):1041, 2010
                                      6. Giri S et al: Hepatotoxicity and hepatic metabolism of available drugs: current problems and possible solutions in preclinical stages. Expert Opin Drug Metab Toxicol. 6(8):895-917, 2010
                                      7. Kim HR et al: Occupational hepatic disorders in Korea. J Korean Med Sci. 25(Suppl):S36-40, 2010
                                      8. Senior JR: Unintended hepatic adverse events associated with cancer chemotherapy. Toxicol Pathol. 38(1):142-7, 2010
                                      9. Teschke R: Kava hepatotoxicity: pathogenetic aspects and prospective considerations. Liver Int. 30(9):1270-9, 2010
                                      10. Carlsen KM et al: Toxic hepatitis induced by infliximab in a patient with rheumatoid arthritis with no relapse after switching to etanercept. Clin Rheumatol. 28(8):1001-3, 2009
                                      11. Gemcitabine: cutaneous, hepatic and vascular disorders. Prescrire Int. 18(101):122, 2009
                                      12. Grattagliano I et al: Biochemical mechanisms in drug-induced liver injury: certainties and doubts. World J Gastroenterol. 15(39):4865-76, 2009
                                      Related Anatomy
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                                      Related Differential Diagnoses
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                                      References
                                      Tables

                                      Tables

                                      KEY FACTS

                                      • Terminology

                                        • Imaging

                                          • Top Differential Diagnoses

                                            • Pathology

                                              • Clinical Issues

                                                • Diagnostic Checklist

                                                  TERMINOLOGY

                                                  • Definitions

                                                    • Injury to liver induced by exogenous toxins, either through direct hepatotoxicity or idiosyncratic reaction

                                                  IMAGING

                                                  • General Features

                                                    • CT Findings

                                                      • MR Findings

                                                        • Ultrasonographic Findings

                                                          • Imaging Recommendations

                                                            DIFFERENTIAL DIAGNOSIS

                                                              PATHOLOGY

                                                              • Staging, Grading, & Classification

                                                                • Microscopic Features

                                                                  CLINICAL ISSUES

                                                                  • Presentation

                                                                    • Natural History & Prognosis

                                                                      • Treatment

                                                                        DIAGNOSTIC CHECKLIST

                                                                        • Image Interpretation Pearls

                                                                          Selected References

                                                                          1. Heard K et al: A single-arm clinical trial of a 48-hour intravenous N-acetylcysteine protocol for treatment of acetaminophen poisoning. Clin Toxicol (Phila). 52(5):512-8, 2014
                                                                          2. Corsini A et al: Drug-induced liver injury: the role of drug metabolism and transport. J Clin Pharmacol. 53(5):463-74, 2013
                                                                          3. Shah AD et al: Understanding lactic acidosis in paracetamol (acetaminophen) poisoning. Br J Clin Pharmacol. 71(1):20-8, 2011
                                                                          4. Ikeda T: Drug-induced idiosyncratic hepatotoxicity: prevention strategy developed after the troglitazone case. Drug Metab Pharmacokinet. 26(1):60-70, 2011
                                                                          5. Akman SA et al: Liver transplantation for acute liver failure due to toxic agent ingestion in children. Pediatr Transplant. 2009 Dec;13(8):1034-40. Epub 2009 Feb 6. Erratum in: Pediatr Transplant. 14(8):1041, 2010
                                                                          6. Giri S et al: Hepatotoxicity and hepatic metabolism of available drugs: current problems and possible solutions in preclinical stages. Expert Opin Drug Metab Toxicol. 6(8):895-917, 2010
                                                                          7. Kim HR et al: Occupational hepatic disorders in Korea. J Korean Med Sci. 25(Suppl):S36-40, 2010
                                                                          8. Senior JR: Unintended hepatic adverse events associated with cancer chemotherapy. Toxicol Pathol. 38(1):142-7, 2010
                                                                          9. Teschke R: Kava hepatotoxicity: pathogenetic aspects and prospective considerations. Liver Int. 30(9):1270-9, 2010
                                                                          10. Carlsen KM et al: Toxic hepatitis induced by infliximab in a patient with rheumatoid arthritis with no relapse after switching to etanercept. Clin Rheumatol. 28(8):1001-3, 2009
                                                                          11. Gemcitabine: cutaneous, hepatic and vascular disorders. Prescrire Int. 18(101):122, 2009
                                                                          12. Grattagliano I et al: Biochemical mechanisms in drug-induced liver injury: certainties and doubts. World J Gastroenterol. 15(39):4865-76, 2009