Focal Nodular Hyperplasia and Hepatic Adenoma
Focal nodular hyperplasia and hepatocellular adenoma are benign liver lesions that occur most frequently in women and may be found as incidental findings on imaging. hepatocellular adenomas may be infrequently associated with malignant progression or risk of rupture and as such, require surveillance or definitive treatments based on their size threshold. It is important clinically to differentiate these lesions, and utilizing imaging modalities such as contrast enhanced ultrasound or magnetic resonance imaging can be helpful in diagnosis. Further molecular subtyping of hepatocellular adenoma lesions may be beneficial to de...
Source: Clinics in Liver Disease - June 3, 2020 Category: Gastroenterology Authors: Lauren Myers, Joseph Ahn Source Type: research

Alpha1-Antitrypsin Deficiency
Alpha1-antitrypsin deficiency (A1ATD) is an inherited cause of chronic liver disease. It is inherited in an autosomal codominant pattern with each inherited allele expressed in the formation of the final protein, which is primarily produced in hepatocytes. The disease usually occurs in pediatric and elderly populations. The disease occurs with the accumulation of abnormal protein polymers within hepatocytes that can induce liver injury and fibrosis. It is a commonly under-recognized and underdiagnosed condition. Patients diagnosed with the disease should be regularly monitored for the development of liver disease. Liver tr...
Source: Clinics in Liver Disease - June 2, 2020 Category: Gastroenterology Authors: Vignan Manne, Kris V. Kowdley Source Type: research

Budd-Chiari Syndrome
Budd-Chiari syndrome (BCS), or hepatic venous outflow obstruction, is a rare cause of liver disease that should not be missed. Variable clinical presentation among patients with BCS necessitates a high index of suspicion to avoid missing this life-threatening diagnosis. BCS is characterized as primary or secondary, depending on etiology of venous obstruction. Most patients with primary BCS have several contributing risk factors leading to a prothrombotic state. A multidisciplinary stepwise approach is integral in treating BCS. Lifelong anticoagulation is recommended. Long-term monitoring of patients for development of cirr...
Source: Clinics in Liver Disease - June 2, 2020 Category: Gastroenterology Authors: Lamia Y.K. Haque, Joseph K. Lim Source Type: research

Transjugular Intrahepatic Portosystemic Shunts
Transjugular intrahepatic portosystemic shunts is an established treatment for portal hypertensive complications. Advancements in technology and technique have led to novel indications, including treatment of chronic portal vein thrombosis and use before abdominal surgery to alleviate portal hypertensive complications. Use of TIPS can facilitate the embolization of large portal-systemic shunts to alleviate refractory hepatic encephalopathy owing to excessive portal shunting. Despite these advances, transjugular intrahepatic portosystemic shunts is an invasive procedure with risk for complications and should be performed at...
Source: Clinics in Liver Disease - May 31, 2020 Category: Gastroenterology Authors: Justin R. Boike, Steven L. Flamm Source Type: research

Thrombocytopenia in Chronic Liver Disease
Thrombocytopenia is common in advanced liver disease, and such patients frequently need invasive procedures. Numerous mechanisms for thrombocytopenia exist, including splenic sequestration and reduction of levels of the platelet growth factor thrombopoietin. Traditionally, platelet transfusions have been used to increase platelet counts before elective procedures, usually to a threshold of greater than or equal to 50,000/ μL, but levels vary by provider, procedure, and specific patient. Recently, the thrombopoietin receptor agonists avatrombopag and lusutrombopag were studied and found efficacious for increasing platele...
Source: Clinics in Liver Disease - May 31, 2020 Category: Gastroenterology Authors: Kathy M. Nilles, Steven L. Flamm Source Type: research

Evaluation and Management of Esophageal and Gastric Varices in Patients with Cirrhosis
This article aims to update outpatient and inpatient strategies to include the latest recommendations on variceal screening and surveillance, primary and secondary prophylaxis of variceal bleeding, and therapy for patients with acute variceal bleeding. (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - May 31, 2020 Category: Gastroenterology Authors: Sofia Simona Jakab, Guadalupe Garcia-Tsao Source Type: research

Cutaneous Manifestations of Chronic Liver Disease
This article covers general cutaneous signs that may correlate with various liver diseases and describes specific cutaneous signs as they relate to more specific liver diseases. (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - May 29, 2020 Category: Gastroenterology Authors: Ashaki D. Patel, Kimberly Katz, Kenneth B. Gordon Source Type: research

Cholangiocarcinoma
is a highly lethal biliary epithelial tumor that is rare in the general population but has increased rates in patients with primary sclerosing cholangitis (PSC). It is heterogenous, and management varies by location. No effective prevention exists, and screening is likely only feasible in PSC. Patients often present in an advanced state with jaundice, weight loss, and cholestatic liver enzymes. Diagnosis requires imaging with magnetic resonance cholangiopancreatography, laboratory testing, and endoscopic retrograde cholangiopancreatography. Potentially curative options include resection and liver transplant with neoadjuva...
Source: Clinics in Liver Disease - May 29, 2020 Category: Gastroenterology Authors: Adam P. Buckholz, Robert S. Brown Source Type: research

Hepatitis B Virus Reactivation
This article defines HBV reactivation, discusses risk stratification and common medications that can induce HBV reactivation as well as guideline recommendations for prevention of HBV reactivation, and describes the prognosis and management of patients who experience HBV reactivation. (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - May 26, 2020 Category: Gastroenterology Authors: Sirina Ekpanyapong, K. Rajender Reddy Source Type: research

Acute on Chronic Liver Failure
Acute on chronic liver failure (ACLF) is an inflammation-based disorder that occurs in patients with underlying liver disease and is characterized by hepatic and extrahepatic organ failure. Morbidity and mortality are high in patients with ACLF, and therefore prevention and early identification are critical to improve outcome. The purpose of this article is to define ACLF, describe ways to identify the expected outcome of ACLF after development, and illustrate interventions to prevent it and when it is not preventable reduce associated morbidity and mortality. (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - May 26, 2020 Category: Gastroenterology Authors: Ariel Aday, Jacqueline G. O ’Leary Source Type: research

Microbiome
The gut microbiome is an exciting new area of research in chronic liver disease. It has shown promise in expanding our understanding of these complicated disease processes and has opened up new treatment modalities. The aim of this review is to increase understanding of the microbiome and explain the collection and analysis process in the context of liver disease. It also looks at our current understanding of the role of the microbiome in the wide spectrum of chronic liver diseases and how it is being used in current therapies and treatments. (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - May 24, 2020 Category: Gastroenterology Authors: Bradley Reuter, Jasmohan S. Bajaj Source Type: research

Pathology in Patients with Chronic Liver Disease
Liver biopsy and histologic examination are the mainstay for diagnosing liver diseases, despite advances in imaging and molecular procedures. Liver biopsy can provide useful information regarding the structural integrity and type and degree of injury, disease activity, response to treatment, progression of disease and degree/staging of fibrosis. Liver biopsies evaluate acute and chronic liver diseases, and mass-forming lesions. The role of the pathologist is to integrate clinical, serologic, and biochemical data with morphologic changes and provide a comprehensive diagnosis. This review focuses on basic principles necessar...
Source: Clinics in Liver Disease - May 11, 2020 Category: Gastroenterology Authors: Audrey Deeken-Draisey, Sambasiva M. Rao, Guang-Yu Yang Source Type: research

Viral Hepatitis Other than A, B, and C
Viral hepatitis can cause a wide spectrum of clinical presentations from a benign form with minimal or no symptoms to acute liver failure or death. Hepatitis D coinfection and superinfection have distinct clinical courses, with the latter more likely leading to chronic infection. Management of chronic hepatitis D virus is individualized because of the paucity of treatment options and significant side effect profile of currently available treatments. Sporadic cases of hepatitis E caused by contaminated meats are becoming increasingly prevalent in immunocompromised hosts. Human herpesviruses are an important cause of disease...
Source: Clinics in Liver Disease - April 23, 2020 Category: Gastroenterology Authors: Amanda Cheung, Paul Kwo Source Type: research

History of Hepatic Encephalopathy
Hippocrates (460-371 bc) first recognized the relationship between the neuropsychological and physiologic changes observed in liver disease (Figs. 1 and 2). At that time, Hippocrates noted that there was a poor clinical outcome associated with delirium that was preceded by jaundice.1 (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - April 1, 2020 Category: Gastroenterology Authors: Vinod K. Rustgi Tags: Preface Source Type: research

Hepatic Encephalopathy
CLINICS IN LIVER DISEASE (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - April 1, 2020 Category: Gastroenterology Authors: Vinod K. Rustgi Source Type: research

Copyright
Elsevier (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - April 1, 2020 Category: Gastroenterology Source Type: research

Contributors
NORMAN GITLIN, MD, FRCP (LONDON), FRCPE (EDINBURGH), FAASLD, FACP, FACG (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - April 1, 2020 Category: Gastroenterology Source Type: research

Contents
Vinod K. Rustgi (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - April 1, 2020 Category: Gastroenterology Source Type: research

Forthcoming Issues
Consultations in Liver Disease (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - April 1, 2020 Category: Gastroenterology Source Type: research

Epidemiology of Hepatic Encephalopathy
This article provides a comprehensive review of the epidemiology of HE. (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - March 2, 2020 Category: Gastroenterology Authors: Mohamed I. Elsaid, Vinod K. Rustgi Source Type: research

Prognosis of Hepatic Encephalopathy
The presence of hepatic encephalopathy is often associated with worse clinical outcomes and increased mortality. Even subclinical hepatic encephalopathy has clinical impacts on daily life and has been linked to increased falls, motor vehicle accidents, and hospitalizations. The presence and degree of hepatic encephalopathy can also affect survival outcomes in cirrhosis, acute liver failure, and liver transplant recipients. Patients may have improved clinical outcomes after treatment of hepatic encephalopathy, but the long-term impact of treatment on prognosis is unclear. (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - March 2, 2020 Category: Gastroenterology Authors: Anita Krishnarao, Fredric D. Gordon Source Type: research

Pharmacologic Management of Hepatic Encephalopathy
This article covers the specific mainstays of therapies, such as antimicrobials and laxatives, with an established evidence base. This article also covers newer modalities of therapies, such as fecal microbiota transplant, probiotics, bioartificial support systems, small molecular therapies such as l-ornithine l-aspartate, branched chain amino acids, l-carnitine, zinc, and other forms of therapy currently under review. (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - March 2, 2020 Category: Gastroenterology Authors: Noah Y. Mahpour, Lauren Pioppo-Phelan, Mishal Reja, Augustine Tawadros, Vinod K. Rustgi Source Type: research

The Health Care Burden of Hepatic Encephalopathy
This article reviews the multidimensional aspects of the health care burden posed by hepatic encephalopathy. (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - March 2, 2020 Category: Gastroenterology Authors: Mohamed I. Elsaid, Tina John, You Li, Sri Ram Pentakota, Vinod K. Rustgi Source Type: research

Social Impact of Hepatic Encephalopathy
Hepatic encephalopathy (HE) is a multifaceted disorder, with effects stretching far beyond office visits and hospitalizations. Patients with HE suffer from varying degrees of altered consciousness, intellectual disability, and personality changes. A large social impact exists for patients with HE. Quality of life and activities of daily living, such as work capacity, driving ability, and sleep quality, have been shown to be affected. Additionally, caregiver and financial burdens are highly prevalent. Multiple tools exist to assess quality of life, including the CLD-Q questionnaire. Common treatments for HE, including rifax...
Source: Clinics in Liver Disease - March 2, 2020 Category: Gastroenterology Authors: Mishal Reja, Lauren Pioppo Phelan, Frank Senatore, Vinod K. Rustgi Source Type: research

Novel Therapies in Hepatic Encephalopathy
Despite widespread use of lactulose and rifaximin for the treatment of hepatic encephalopathy, this complication of advanced liver disease remains a major burden on the health care system in the United States and continues to predispose to high morbidity and mortality. Several agents have surfaced over recent years with promise to treat hepatic encephalopathy and mitigate the cognitive impairment associated with this disease process. The purpose of this article is to highlight the leading emerging therapies in hepatic encephalopathy as well as their therapeutic targets. (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - March 2, 2020 Category: Gastroenterology Authors: Maryam Alimirah, Omar Sadiq, Stuart C. Gordon Source Type: research

Clinical Manifestations of Hepatic Encephalopathy
Hepatic encephalopathy (HE) occurs in patients with acute-on-chronic liver disease. It has a wide progression of symptoms, with its initial presentation being subtle. The symptoms of HE mainly affect mental status, the musculoskeletal system, and mood/behavior. Its severity ranges from minor disturbances in sleep-wake cycle to the patient being comatose. HE is categorized based on 4 main features: the underlying disease, the severity of manifestations, the time course, and whether precipitating factors are present. The severity of the manifestations is classically identified using the West Haven Criteria. There are several...
Source: Clinics in Liver Disease - March 2, 2020 Category: Gastroenterology Authors: Peter Dellatore, Maggie Cheung, Noah Y. Mahpour, Augustine Tawadros, Vinod K. Rustgi Source Type: research

Laboratory Abnormalities of Hepatic Encephalopathy
Currently, there is no gold standard serologic or imaging modality to detect hepatic encephalopathy (HE). It is a clinical diagnosis gathered from the history and physical. Imaging is nonspecific; however, PET and MRI have shown areas of utility, but are not widely available, cost-efficient, or necessary for diagnosis. Electroencephalogram has shown promise as it can be used in conjunction with the Portal Systemic Hepatic Encephalopathy Score test to diagnose minimal HE. Further research on these techniques would need to be performed to identify strict criteria and cutoffs for diagnosing HE as well as associated sensitivit...
Source: Clinics in Liver Disease - March 2, 2020 Category: Gastroenterology Authors: Briette Verken Karanfilian, Maggie Cheung, Peter Dellatore, Taeyang Park, Vinod K. Rustgi Source Type: research

Minimal Hepatic Encephalopathy
Minimal hepatic encephalopathy, previously called subclinical hepatic encephalopathy, represents the earliest and mildest form of hepatic encephalopathy. It is the most under-recognized and underdiagnosed form of hepatic encephalopathy. Although there is no diagnostic gold standard, validated testing modalities have been devised to detect this neurocognitive complication. The newest developments include medically related apps for smartphones or tablets that can be easily used to diagnose and monitor minimal hepatic encephalopathy. Although recognition of this neurocognitive impairment can be challenging, early detection is...
Source: Clinics in Liver Disease - March 2, 2020 Category: Gastroenterology Authors: Briette Verken Karanfilian, Tae Yang Park, Frank Senatore Source Type: research

Nonpharmacologic Management of Hepatic Encephalopathy
Research increasingly shows that the gut-liver-brain axis is a crucial component in the pathophysiology of hepatic encephalopathy (HE). Due to the limitations of current standard-of-care medications, non-pharmacological treatments that target gut dysbiosis, including probiotics, nutritional management, and fecal microbiota transplants, are being considered as alternative and adjunct therapies. Meta-analyses note that probiotics could offer benefits in HE treatment, but have not shown superiority over lactulose. Emerging literature suggests that fecal microbiota transplants could offer a novel strategy to treat gut dysbiosi...
Source: Clinics in Liver Disease - February 26, 2020 Category: Gastroenterology Authors: Vanessa Weir, K. Rajender Reddy Source Type: research

Long-Term Management
This article discusses current and potential future techniques to improve outcomes in these vulnerable patients. (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - February 26, 2020 Category: Gastroenterology Authors: Russell Rosenblatt, Johnathan Yeh, Paul J. Gaglio Source Type: research

Pathophysiology of Hepatic Encephalopathy
Hepatic encephalopathy (HE) is one of the major clinical decompensations of cirrhosis, with a high impact on health care resource utilization and cost. For an effective and comprehensive management of HE, the clinicians need to understand the pathophysiologic mechanisms of HE. This review describes the multiorgan processes involved in HE and how several HE precipitants and treatment strategies act on ammonia production, excretion, and neurotoxicity, including the impact of diabetes and use of cannabinoids. The authors also discuss the current and future role of gut microbiome, systemic/central inflammation, and various neu...
Source: Clinics in Liver Disease - February 18, 2020 Category: Gastroenterology Authors: Ariel Jaffe, Joseph K. Lim, Sofia Simona Jakab Source Type: research

Drug-Induced Liver Injury from Statins
The hydroxymethyglutaryl-coenzyme A reductase inhibitors (statins) are a commonly prescribed class of medication for the treatment of hyperlipidemia and coronary artery disease. This class of medication has several proven benefits, including reduction of mortality related to coronary artery disease. A major consideration when prescribing these drugs are the potential for adverse effects, mainly myalgias, myopathy, and hepatotoxicity. In this article, we summarize current data on statin-associated hepatotoxicity and highlight that the risk of clinically significant idiosyncratic drug-induced liver injury is actually quite s...
Source: Clinics in Liver Disease - November 19, 2019 Category: Gastroenterology Authors: Lindsay Meurer, Stanley Martin Cohen Source Type: research

A Focus on Drug-Induced Liver Injury
Drug-induced liver injury (DILI) is a clinically relevant, costly, and potentially catastrophic condition that affects persons in diverse settings of care. As indications for pharmacotherapy expand with the development of new drugs, so also does the potential for DILI in a greater number of people. The expansion of access to health care, including prescription drug coverage, in the United States may put more persons at risk for DILI. Though not well studied, it appears that recognition of patterns of injury consistent with DILI may not be optimal in primary care and even a more specialized setting. (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - November 19, 2019 Category: Gastroenterology Authors: Pierre M. Gholam Tags: Preface Source Type: research

Drug Hepatotoxicity
CLINICS IN LIVER DISEASE (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - November 19, 2019 Category: Gastroenterology Authors: Pierre M. Gholam Source Type: research

Copyright
Elsevier (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - November 19, 2019 Category: Gastroenterology Source Type: research

Contributors
NORMAN GITLIN, MD, FRCP (LONDON), FRCPE (EDINBURGH), FAASLD, FACP, FACG (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - November 19, 2019 Category: Gastroenterology Source Type: research

Contents
Pierre M. Gholam (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - November 19, 2019 Category: Gastroenterology Source Type: research

Forthcoming Issues
Hepatic Encephalopathy (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - November 19, 2019 Category: Gastroenterology Source Type: research

Drug-Induced Liver Injury in the Setting of Analgesic Use
No professional society has created guidelines to aid clinicians in the management of analgesics in the setting of hepatic injury. Acetaminophen overdose is the most common cause of acute liver failure in the United States. In the setting of acetaminophen toxicity, N-acetylcysteine remains the standard of care. Other analgesics including nonsteroidal antiinflammatory drugs, opiates, tricyclic antidepressants, and anticonvulsants rarely cause liver injury. (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - November 1, 2019 Category: Gastroenterology Authors: Umar Darr, Norman Leslie Sussman Source Type: research

Quantitative Systems Toxicology Approaches to Understand and Predict Drug-Induced Liver Injury
The DILI-sim Initiative is a public-private partnership using quantitative systems toxicology to build a model (DILIsym) capable of understanding and predicting liver safety liabilities in drug candidates. The effort has provided insights into mechanisms underlying dose-dependent drug-induced liver injury (DILI) and interpatient differences in susceptibility to dose-dependent DILI. DILIsym may be useful in identifying drugs capable of causing idiosyncratic hepatotoxicity. DILIsym is used to optimize interpretation of traditional and newer serum biomarkers of DILI. DILIsym results are considered in drug development decision...
Source: Clinics in Liver Disease - October 31, 2019 Category: Gastroenterology Authors: Paul B. Watkins Source Type: research

Genetic Predisposition to Drug-Induced Liver Injury
Identification of genetic predisposition to drug-induced liver injury (DILI) is of paramount importance. Early candidate gene studies have identified various polymorphisms in drug-metabolizing genes that infer increased DILI susceptibility. Few of these have been confirmed in more recent genome-wide association studies, which have identified several specific human leukocyte antigen (HLA) alleles. The low incidence rate of DILI, however, leads to a low positive predictive value for currently identified genetic variations, making them unsuitable for pre-prescription screening. HLA screening incorporated into clinical practic...
Source: Clinics in Liver Disease - October 30, 2019 Category: Gastroenterology Authors: Camilla Stephens, Ra úl J. Andrade Source Type: research

Drug Hepatotoxicity
Drug induced liver injury is a diagnosis that relies on the patterns of injury associated with specific medications and toxins. The process by which a clinician determines which agent is the likely culprit of the liver injury is called causality assessment. The Roussel Uclaf Causality Assessment Method (RUCAM) and additional causality assessment methods have been developed with the goal of providing a more standardized, less subjective approach to causality assessment. RUCAM remains the most used standardized method, however many physicians continue to rely on their experience for causality assessment. (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - October 30, 2019 Category: Gastroenterology Authors: Allyce Caines, Dilip Moonka Source Type: research

Liver Histology
When patients with suspected drug-induced liver injury (DILI) undergo liver biopsy, the pathologist can provide a wealth of information on the morphologic changes. The most common histologic patterns of DILI include mimics of acute and chronic hepatitis as well as acute cholestasis, chronic cholestasis, and a mixed pattern that combines hepatitis with cholestasis. The pattern may suggest etiologies of injury or correlate with reported patterns of injury for specific agents. Biopsy may exonerate or indict particular drugs as causal agents of injury and provide specific information on severity of injury and specific types of...
Source: Clinics in Liver Disease - October 30, 2019 Category: Gastroenterology Authors: Billel Gasmi, David E. Kleiner Source Type: research

Acute Liver Failure Secondary to Drug-Induced Liver Injury
Drug-induced liver injury (DILI) is the most common cause of acute liver failure (ALF) in Western countries. Without liver transplantation, the mortality rate for ALF approaches greater than 80%. Acetaminophen-related ALF may be associated with a rapid progression but fortunately has a high chance for spontaneous survival compared with idiosyncratic DILI –related ALF. Several prognostic scoring systems for severe DILI have been developed to aid clinicians in selecting patients who require urgent liver transplantation. Patients who undergo liver transplantation for ALF are at risk for early graft loss and death and sh...
Source: Clinics in Liver Disease - October 30, 2019 Category: Gastroenterology Authors: Maneerat Chayanupatkul, Thomas D. Schiano Source Type: research

Drug-Induced Liver Injury in the Setting of Chronic Liver Disease
Drug-induced liver injury (DILI) is an uncommon but significant cause of liver injury and need for liver transplant. DILI in the setting of chronic liver disease (CLD) is poorly understood. Clinical features of patients presenting with DILI in the setting of CLD are similar to those without CLD with the exception of a higher incidence of diabetes among those with CLD and DILI. Diagnosis of DILI in CLD is difficult because there are no objective biomarkers and current causality assessments have not been studied in this population. Differentiating DILI from exacerbation of underlying liver disease is even more challenging. (...
Source: Clinics in Liver Disease - October 30, 2019 Category: Gastroenterology Authors: Nicholas A. Hoppmann, Meagan E. Gray, Brendan M. McGuire Source Type: research

Drug-induced Liver Injury Secondary to Herbal and Dietary Supplements
This article reviews the impact of liver injury cause by HDS and explores the hepatotoxic potential of such products and their individual ingredients. (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - October 30, 2019 Category: Gastroenterology Authors: Elizabeth Zheng, Naemat Sandhu, Victor Navarro Source Type: research

Drug-Induced Liver Injury Resources and Reporting for the Clinician
Although many risk factors for developing drug-induced liver injury (DILI) have been identified and more than 1000 medications and herbal and dietary supplements are known to cause liver dysfunction, idiosyncratic drug reactions remain unpredictable and erratic. Varying effects of individual drugs on the event cascade and patient genetic polymorphisms lead to different clinical presentations. Mechanisms and causality scales have been developed to guide the clinician in diagnosis, and several databases and registries are available for reference and reporting. We identify and summarize the resources available to clinicians t...
Source: Clinics in Liver Disease - October 30, 2019 Category: Gastroenterology Authors: Marisa Isaacson, Michael Babich Source Type: research

Epidemiology, Predisposing Factors, and Outcomes of Drug-Induced Liver Injury
Idiosyncratic drug-induced liver injury (DILI) is an underreported and underestimated adverse drug reaction. A recent population-based study found a crude incidence of approximately 19 cases per 100,000 a year. Amoxicillin-clavulanate continues to be the most commonly implicated agent in most Western countries, reported to occur in approximately 1 of 2300 users. In patients with drug-induced autoimmune hepatitis, liver tests often do not normalize with cessation of the drugs and require corticosteroids. DILI associated with jaundice can lead to death from liver failure or require liver transplantation in at least 10% of ca...
Source: Clinics in Liver Disease - October 28, 2019 Category: Gastroenterology Authors: Einar S. Bj örnsson Source Type: research

Frequent Offenders and Patterns of Injury
Given the liver ’s role in drug metabolism, it is uniquely sensitive to potential drug-induced liver injury (DILI) despite inherent protective mechanisms. In this article, we focus on the most common causes of DILI and their patterns of injury. Although not comprehensive, we attempt to cover several classes of co mmonly used drugs, and their associated patterns of injury and management. (Source: Clinics in Liver Disease)
Source: Clinics in Liver Disease - October 28, 2019 Category: Gastroenterology Authors: Jinyu Zhang, Deepak Venkat Source Type: research

Noncirrhotic Portal Hypertension
Idiopathic portal hypertension (IPH) and extrahepatic portal venous obstruction (EHPVO) are prototype noncirrhotic causes of portal hypertension (PHT), characterized by normal hepatic venous pressure gradient, variceal bleeds, and moderate to massive splenomegaly with preserved liver synthetic functions. Infections, toxins, and immunologic, prothrombotic and genetic disorders are possible causes in IPH, whereas prothrombotic and local factors around the portal vein lead to EHPVO. Growth failure, portal biliopathy, and minimal hepatic encephalopathy are long-term concerns in EHPVO. Surgical shunts and transjugular intrahepa...
Source: Clinics in Liver Disease - September 26, 2019 Category: Gastroenterology Authors: Rajeev Khanna, Shiv Kumar Sarin Source Type: research