2019 Webinar: The Diverse Presentation and Diagnosis of Liver Injury Due to Drugs or Herbal and Dietary Supplements-The Diverse Presentation and Diagnosis of Liver Injury Due to Drugs or Herbal and Dietary Supplements

The Diverse Presentation and Diagnosis of Liver Injury Due to Drugs or Herbal and Dietary Supplements

Video Transcription

Video Summary

This webinar, presented by AASLD’s Hepatotoxicity Special Interest Group, covered the diverse ways drug-induced liver injury (DILI) and liver injury from herbal and dietary supplements can present and how clinicians should evaluate it.<br /><br />Dr. Andrew Stolls reviewed clinical presentations, emphasizing that DILI may be silent or cause symptoms such as jaundice, dark urine, fatigue, nausea, itching, abdominal pain, rash, or rarely adenopathy. He explained how liver injury patterns are classified using the R-value: hepatocellular, cholestatic, or mixed. He highlighted common causes including antibiotics, acetaminophen, diclofenac, isoniazid, green tea extracts, anabolic steroids, and multi-ingredient supplements. He also described unusual forms such as autoimmune-like hepatitis, sclerosing cholangitis, vascular injury, steatohepatitis, vanishing bile duct syndrome, and checkpoint inhibitor-related injury. Prognosis was stressed, especially the higher risk when jaundice is present.<br /><br />Dr. Skip Hayashi focused on diagnosis. He emphasized careful history-taking, precise timing, pharmacy verification, and use of the EMR and LiverTox. He reviewed the RUCAM causality tool and the need to exclude competing diagnoses like viral hepatitis, biliary obstruction, autoimmune hepatitis, alcohol-related injury, ischemia, and infections such as CMV, EBV, and hepatitis E. He noted that DILI is increasingly common in older patients and that herbal supplements account for a growing share of cases.<br /><br />Both speakers stressed that treatment is usually supportive after stopping the offending agent.

Asset Caption

Presenter: Paul (Skip) Hayashi, MD, MPH, FAASLD and Andrew Stolz, MD
Moderator: Adrian Reuben, MBBS, FRCP, FACG, FAASLD

Keywords

drug-induced liver injury

DILI

herbal and dietary supplements

R-value

hepatocellular injury

cholestatic injury

RUCAM causality assessment

LiverTox

supportive treatment