Acute Liver Injury

Today we discussed a case of acute liver injury related to use of green tea supplements (for weight loss) in a previously healthy young woman presenting with jaundice, abdominal pain, and nausea. We discussed approaches to jaundice and LFTs.

Jaundice can result from prehepatic, intrahepatic, and extrahepatic causes as illustrated here.

Also, the pattern of LFTs can help narrow our differential:

  • Hepatocellular: predominantly elevation in transaminases (+/- alk phos and bili)--often related to viral infection, autoimmune disease, vascular/ischemia, drugs/toxins, non-alcoholic fatty liver disease
  • Cholestatic: mostly alk phos and bili elevation (+/- AST/ALT)--can present with or without ductal dilation (if dilated, can think of biliary obstruction from stones or malignancies); if not dilated intrahepatic cholestasis from sepsis, PBC, or meds can be considered or types of biliary epithelial damage such as cirrhosis)  
  • Isolated hyperbilirubinemia: if conjugated this is related to excretion issues like Rotors or Criglar Najjar but if it is unconjugated, hemolysis (overproduction) or Gilberts (defective conjugation) could be considered
  • Infiltrative: seen with predominantly elevated alkaline phosphatase (evoking malignancy, granulomatous disease, abscess formation, or meds)

A great resource for clinical and research information on DILI can be found at https://livertox.nlm.nih.gov/