Hepatotoxicity: newer aspects of pathogenesis and treatment.
The etiology and the pathogenesis of different forms of hepatotoxicity are discussed; case reports are included to illustrate the importance of history-taking and examination of liver tissue in establishing a specific diagnosis. The role of alcohol as a hepatotoxin as well as an enzyme-inducing agent is stressed. Genetic factors have been identified that may determine susceptibility to alcoholism and the hepatotoxic effects of alcohol and other compounds. Some cases of drug-induced cholestasis may be explained by disturbances in the known pathways of bile acid uptake, transport, and excretion. The importance of small duct destruction in patients with progressive drug-induced cholestasis is discussed. Finally, the potential hepatic complications of some nonprescription remedies used by adherents of "alternative medicine" are described, emphasizing the relevance of thorough etiological inquiry in all patients presenting with hepatic dysfunction.
Heathcote
J
J
Department of Medicine, Toronto Hospital, Canada.
Wanless
I R
IR
D000082:Acetaminophen / Q000009:adverse effects; D000111:Acetylcysteine / Q000627:therapeutic use; D018248:Adenoma, Liver Cell / Q000139:chemically induced; D000328:Adult; D000658:Amoxicillin / Q000009:adverse effects; D045930:Anabolic Agents / Q000009:adverse effects; D001628:Beverages / Q000009:adverse effects; D056486:Chemical and Drug Induced Liver Injury / Q000188:drug therapy / Q000209:etiology*; D002780:Cholestasis, Intrahepatic / Q000139:chemically induced; D003276:Contraceptives, Oral / Q000009:adverse effects; D005260:Female; D006801:Humans; D007538:Isoniazid / Q000009:adverse effects; D008107:Liver Diseases / Q000188:drug therapy; D008108:Liver Diseases, Alcoholic / Q000188:drug therapy / Q000209:etiology; D008113:Liver Neoplasms / Q000139:chemically induced; D008297:Male; D004366:Nonprescription Drugs / Q000009:adverse effects; D011441:Propylthiouracil / Q000627:therapeutic use; D012293:Rifampin / Q000009:adverse effects
D045930:Anabolic Agents; D003276:Contraceptives, Oral; D004366:Nonprescription Drugs; D000082:Acetaminophen; D011441:Propylthiouracil; D000658:Amoxicillin; D007538:Isoniazid; D012293:Rifampin; D000111:Acetylcysteine