Drug and Toxin-Induced Liver Disease

General features

 - Genetic variability is a critical factor
 - Injury of hepatocytes or biliary epithelium causing cell death or disruption of cellular function may result

  * From direct toxicity
  * through hepatic conversion of a xenobiotic   to an active toxin
 * through immune mechanisms, usually by a    drug or a metabolite acting as a hapten

Mechanisms

 - Predictable, occurs in anyone who receives sufficient dose of an agent

 - Unpredictable (idiosyncratic), depends on

 * Rate of metabolism of the agent

 * Intensity of immune response

Morphology

 - Hepatocyte necrosis
 - Cholestasis
 - Chronic hepatitis
 - Micro & macrovesicular steatosis

·        Clinically & histologically is similar to chronic viral hepatitis, distinction is made by serology.

·        Recovery upon removal of the drug.