Drug Induced Liver Disease (cont.)
Hepatic vein thrombosis
Normally, blood from the intestines is delivered to the
liver via the portal vein, and the blood leaving the liver for the heart is carried via the hepatic
veins into the inferior vena cava
(the large vein that drains into the heart). Certain drugs can cause blood clots
to form (thrombosis) in the hepatic veins and in the inferior vena cava. Thrombosis of the hepatic vein and inferior vena
cava can lead to an enlarged liver, abdominal pain, fluid collection in the
abdomen (ascites), and liver failure. This syndrome is called the Budd Chiari
syndrome. The most important drugs that cause Budd-Chiari syndrome are birth
control pills (oral contraceptives). Birth control pills also can cause a
related disease called veno-occlusive disease in which blood clots only in the
smallest hepatic veins. Pyrrolizidine alkaloids found in certain herbs (e.g.,
borage, comfrey) also can cause veno-occlusive disease.
How is drug-induced liver disease diagnosed?
The diagnosis of drug-induced liver diseases often is difficult. Patients may
not have symptoms of liver disease or may have only mild, nonspecific symptoms.
Patients may be taking multiple drugs, which makes it difficult to identify the
offending drug. Patients also may have other potential causes of liver diseases
such as non-alcoholic fatty liver disease (NAFLD) and alcoholism.
The diagnosis of liver disease is based on a patient's
symptoms (such as loss of appetite, nausea, fatigue, itching, and dark urine),
findings on the physical examination (such as jaundice, enlarged liver), and
abnormal laboratory tests
(such as blood levels of liver enzymes or bilirubin and blood clotting times).
If a patient has symptoms, signs, and abnormal liver tests, doctors then try to
decide whether drug(s) are causing the liver disease by:
- Taking a careful history of alcohol consumption to
exclude alcoholic liver disease.
- Performing blood tests to exclude viral
hepatitis B and
hepatitis C
, and to exclude chronic liver diseases such as autoimmune hepatitis and
primary biliary cirrhosis (PBC).
- Performing abdominal ultrasound or
computerized tomography (CT) scan
of the liver to exclude gallbladder disease and tumors of
the liver.
- Taking a careful history of ingestion-particularly recent initiation--of
drugs that are commonly associated with liver disease.
Next: What is the treatment for drug-induced liver disease? »
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