Table 3 Common causes of severe liver injury
From: A case report of nifedipine-induced hepatitis with jaundice
Category | Common examples | Additional investigations |
|---|---|---|
Drug-induced hepatitis | Dose-dependent Idiosyncratic | Medication history, rule out other possible causes, CBC, liver biopsy |
Viral hepatitis | Hepatitis A, B, C, D, and E Epstein–Barr (EBV) virus Cytomegalovirus (CMV) Human immunodeficiency virus (HIV), HSV, Parvovirus B19 | Drug and travel history, hepatitis A IgM, hepatitis B surface antigen (HBsAg), anti-HBc, anti-HBs, anti-HCV, anti-HBc-IgM, HBeAg, monotest, EBV serology, EBV DNA by PCR, CMV serology, CMV DNA by PCR, HIV antibody |
Alcoholic hepatitis | Ethanol ingestion | Serum ethanol level, AST to ALT ratio (2:1 or greater may suggest ethanol injury) |
Toxic hepatitis | Vinyl chloride Pyrrolizidine alkaloids (i.e. found in certain teas) Poisonous mushrooms | Diet history, vinyl chloride breath test or urine test for thiodiglycolic acid |
Autoimmune hepatitis | Overlap autoimmune hepatitis Type 1 autoimmune hepatitis Type 2 autoimmune hepatitis | In general, consider: total IgG, gamma-globulin level, anti-soluble liver antigen or liver pancreas (anti-SLA/LP) antibody, liver biopsy Anti-nuclear antibody (ANA), anti-smooth muscle antibody (ASMA), anti-actin antibody (AAA), anti-dsDNA antibody, anti-soluble liver antigens (SLA) antibody, anti-neutrophil cytoplasmic antibody (ANCA), anti-mitochondrial antibody (AMA) Anti-liver kidney microsomal 1 (anti-LKM1) antibody, anti-liver cytosol antigen (anti-LC1), atypical p-ANCA (pANNA), anti-soluble liver antigens (SLA) |
Ischemic hepatitis | Budd-Chiari syndrome (hepatic vein obstruction) Shock | CBC, lactate, hypercoagulopathy workup, age-appropriate malignancy workup, abdominal ultrasound, CT, or MRI |