Toxic hepatitis

Diagnosis

The process of diagnosing toxic hepatitis typically involves a thorough inquiry into one’s medical history and conducting a physical examination. The doctor will inquire about the usage of prescribed medications, over-the-counter drugs, vitamins, and herbal supplements, as well as the frequency of alcohol consumption. It is advisable to bring the original packaging of all medications when visiting the doctor to aid in the consultation.

During the physical examination, the physician will assess the abdomen for any signs of tenderness, swelling, or pain. It is important to inform the doctor about any occupational exposure to toxins as it can aid in the diagnosis. To confirm the condition, several tests may be necessary, including:

• Imaging tests: A doctor may recommend an imaging test to generate an image of the liver using ultrasound, computerized tomography (CT), or magnetic resonance imaging (MRI). Additional imaging tests that could be suggested including magnetic elastography and transient elastography.
• Blood tests: These aims to check for elevated levels of specific liver enzymes and bilirubin in the blood. Bilirubin is a byproduct of the breakdown of old blood cells. The enzyme levels can indicate how well the liver is working. If blood levels of liver enzymes and bilirubin are higher than normal, it can indicate liver damage.
• Overdose tests: To screen for excessive levels of drugs or alcohol, blood and urine tests may be performed.
• Liver biopsy: A liver biopsy is a procedure that aids in confirming the diagnosis of toxic hepatitis and ruling out other potential causes. It involves using a needle to extract a small tissue sample from the liver, which is then examined under a microscope.

Treatment

The treatment approach for toxic hepatitis is contingent upon the underlying cause of the condition. Typically, discontinuing exposure to the harmful substance responsible for liver inflammation is the primary step in alleviating symptoms. While the liver possesses the ability to regenerate and replace damaged liver cells, noticeable improvement may require several weeks or months to manifest.

There are several treatments available for toxic hepatitis, such as:

• Supportive care: The healthcare provider will closely monitor for any indications of liver damage. To relieve severe symptoms such as vomiting and nausea, supportive care in a hospital setting may be necessary. Drugs and intravenous fluids may be administered.
• Medications for acetaminophen-induced liver damage: Administering acetylcysteine promptly after an acetaminophen overdose is crucial for mitigating liver damage. The effectiveness of this medication in limiting harm is significantly enhanced when given within 16 hours of the overdose.
• Emergency medical attention: Emergency care is crucial for individuals who experience an overdose of a toxic medication. In cases where the overdose involves medications other than acetaminophen, specific treatments may be beneficial in eliminating the harmful substance from the body or mitigating its toxic effects.
• Liver transplantation: Cases where liver function is severely compromised, a liver transplant may be the only available option. This surgical procedure involves the removal of the diseased liver and its replacement with a healthy liver from either a deceased or living donor. While most liver transplants utilize organs from deceased donors, there are instances where a living donor can donate a portion of their liver for transplantation.