Drug Induced Liver Injury

Question 1

What does DILI cause

Answer 1

Liver disease and failure

Question 2

How can DILI be presented

Answer 2

Hepatitis (liver cell necrosis)
Cholestasis (reduced or blocked bile flow)
Injury

Question 3

What are the mechanisms of DILI

Answer 3

Toxicity of administered drugs
Producing toxic metabolites
Immune mechanism injury

Question 4

How does paracetamol cause DILI

Answer 4

Mitochondrial dysfunction causes free radicals and oxidative stress in paracetamol hepatotoxicity

Question 5

How does Amiodarone cause DILI

Answer 5

Direct damage to lipid belayer and disturbance of lysosomal and or mitochondrial function

Question 6

What are the risk factors for DILI (5)

Answer 6

Pre existing liver injury
Chronic alcohol consumption
Non-alcoholic fatty liver disease
Polymorphic variants of drug metabolism enzymes - exacerbate reactive intermediates
HLA phenotype (immune mediated DILI)

Question 7

What are diagnostic markers for DILI

Answer 7

Increases in AST, ALT, AP and bilirubin

Question 8

What are the treatment options for DILI

Answer 8

Stopping drug that’s causing it and monitoring liver function

Question 9

What is the antidote should you overdose on paracetamol

Answer 9

N-acetylcysteine