Drug Induced Liver Injury

Drug Induced Liver Injury
Presentation by:Robert J. Fontana, MD
University of Michigan Medical Center

Drug Induced Liver Injury
Hepatic Adverse Event Nomenclature
Liver Injury Classification
DILI Population based study
DILI Diagnosis
Clinicopathologic forms of DILI
DILI: A Diagnosis of exclusion
Acute Hepatocellular: Differential Dx
Ultrasound/ CT
DILI: Causality Assessment
RUCAM
RUCAM limitations
Prognosis in DILI with jaundice
Spectrum of DILI
ALT monitoring and DILI
DILI pathogenesis
DILIN: Sphere of Influence
Idiosyncratic Liver Injury Associated with Drugs (ILIAD)
New agent signals
Drug
Human genome
DILIN Genotyping Initiative
Acetaminophen: Friend or foe ?
Glucuronyl transferases sulfotransferases
Acetaminophen
ACM-cysteine adducts
Biomarker for ACM hepatotoxicity
Implications of ACM related ALF
Acetaminophen advice
Acetaminophen toxicity in severe acute HAV/ HBV
Prospective Study Design
DILI Causality Instrument
Prognosis in DILI with jaundice

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Viral Hepatitis Medicine Student Lecture

Viral Hepatitis Medicine Student Lecture
Presentation by:David R Nelson, M.D.

Associate Professor of Medicine
Director, Hepatology and Liver Transplantation
University of Florida

Causes of Acute Hepatitis

Acute Hepatitis
Viral Hepatitis
A, B/D, C, E
EBV
CMV & HSV
Drugs
Ethanol
Tylenol
Halothane
Toxins
Jamaica Bush Tea
Mushrooms
Vascular
Hypotension
Budd-Chiari
Autoimmune
Hepatitis
Metabolic
Wilson's Disease
A1AT

Causes of Chronic Hepatitis
Chronic Hepatitis
Viral Hepatitis
Drugs
MTX
INH
Amiodarone
Alcohol
NAFLD
Autoimmune
AIH
PBC
PSC
Metabolic
A1AT
HHC

Hepatitis A Virus
Nucleic Acid: 7.5 kb ssRNA
HAV Prevalence
Global Prevalence of Hepatitis A Infection
Hepatitis A Prevention - Immune Globulin

ACIP Recommendations MMWR 1999; 48(RR12):1
Hepatitis A: Pre-exposure Vaccination
Persons at increased risk or danger of infection
Hepatitis E

Clinical Characteristics
Hepatitis B Virus
HBsAg
HBV DNA
HBcAg
HBV Sources of Infection
Signs and Symptoms of Acute Hepatitis B

Hepatitis B - Clinical Features
Progression to Chronic Hepatitis B Virus Infection
Typical Serologic Course
Recovery from acute hepatitis B
Chronic HBeAg + disease
Chronic HBeAG – disease
Successful Vaccination
Resistance to antiviral agents
Hepatitis B: Disease Progression
Acute Infection
Chronic HBV is the 6th leading cause of liver transplantation in the US
Higher in HIV, immune suppressed
Targeted Surveillance for HCC
Hepatitis B Carriers
Non-hepatitis B Cirrhosis
Prevention of Transmission of Hepatitis B

and much more are discussed in this presentation.
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Treatment for Chronic Hepatitis B

Treatment for Chronic Hepatitis B
Screening for Hepatocellular Carcinoma
Presentation by: Mindie H. Nguyen, MD, MAS

Assistant Professor of Medicine
Division of Gastroenterology & Hepatology
Liver Transplant Program
Stanford University Medical Center

Chronic Hepatitis B
HBV Disease Burden in Asian-Americans
Hepatitis B Prevalence
Etiology of HCC in Asians
Impact of HBV DNA and ALT Levels on Disease Outcomes
HBV DNA Levels,
Disease Progression and HCC Risk
Impact of Viral Load
HBV DNA Associated with Increased Risk of HCC
HBV DNA levels and Risk of Cirrhosis and HCC REVEAL-HBV Study
HBV DNA Levels Predict Risk of Developing Cirrhosis
HBV DNA Levels Predict Risk of Developing HCC
Dose-Response Relationship:
HBV DNA and HCC
REVEAL-HBV Study: HCC Analysis Conclusions
Impact of Treatment on Disease Progression
Primary Goal of Treatment
Rapid and sustained suppression of HBV to the lowest possible level1,2
Rapid and Profound HBV Suppression: an Important Therapeutic Goal
Lamivudine and Disease Progression and HCC incidence in Advanced HBV (stage III/IV)
HBV DNA Suppression Reduces HCC Incidence Rate
Screening for Hepatocellular Carcinoma
HCC: Screening Tests
HCC: Screening Strategies and Frequency
WHO Principles of Screening
Screening improves survival
HCC Screening: clinical studies
RCT for HCC Screening

Treatment for Chronic Hepatitis B

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