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Harrison's Principles of Internal Medicine, 18e
| Part 14. Disorders of the Gastrointestinal System > Section 2. Liver and Biliary Tract Disease > |
Chapter 305. Toxic and Drug-Induced Hepatitis
Sections: Toxic and Drug-Induced Hepatitis: Introduction, Acknowledgement, Further Readings.
Topics Discussed: hepatitis, drug-induced; liver disease, drug-induced; toxic responses of the liver.
Excerpt:"Liver injury may follow the inhalation, ingestion, or parenteral administration of a number of pharmacologic and chemical agents. These include industrial toxins (e.g., carbon tetrachloride, trichloroethylene, and yellow phosphorus); the heat-stable toxic bicyclic octapeptides of certain species of Amanita and Galerina (hepatotoxic mushroom poisoning); and, more commonly, pharmacologic agents used in medical therapy. Among patients with acute liver failure, drug-induced liver injury is the cause in a majority of all cases, and liver toxicity accounts for the abandonment of many new drugs during their development. It is essential that any patient presenting with jaundice or altered biochemical liver tests be questioned carefully about exposure to chemicals used in work or at home, drugs taken by prescription or bought over the counter, and herbal or alternative medicines. Hepatotoxic drugs can injure the hepatocyte directly (e.g., via a free-radical or metabolic intermediate that causes peroxidation of membrane lipids and that results in liver cell injury). Alternatively, the drug or its metabolite can distort cell membranes or other cellular molecules, bind covalently to intracellular proteins, activate apoptotic pathways, interfere with bile salt export proteins, or block..."
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