Symptoms to Treatment of Toxic Liver Injury

Symptoms

In general, even when there is liver disease, many cases are asymptomatic with no symptoms, and even when symptoms do appear, they are mostly nonspecific symptoms such as fatigue, loss of appetite, and indigestion. A characteristic of liver disease is that symptoms known to be specific to liver disease, such as jaundice and ascites, only appear once the disease has progressed significantly. Toxic liver injury has the same characteristics, so it is very difficult to diagnose based on symptoms alone.

Diagnosis

In general, the most widely used test to diagnose liver disease (or liver injury) is the 'liver function test' (blood test), which includes AST (SGOT) and ALT (SGPT). Each item in these liver function tests has a slightly different meaning, and rather than judging based on a single item at a glance, it is necessary to evaluate them comprehensively.

Toxic liver injury is very similar to liver injury caused by other causes (for example, viral hepatitis), and a single drug can also cause various types of liver injury, so it is not easy to identify the relationship between the causative substance and liver injury. Therefore, toxic liver injury is diagnosed by comprehensively considering the history of exposure to the causative substance, clinical symptoms, laboratory findings, and the degree of recovery from liver injury after stopping the suspected substance.

Treatment

In some cases, such as acetaminophen (Tylenol) poisoning, a specific antidote is used, but most toxic liver injuries do not have an antidote. Therefore, the principle of treatment is to identify the suspected substance as quickly as possible and stop taking it, while at the same time providing supportive treatment for the liver injury. If very severe toxic liver injury occurs and the patient's life is in danger, liver transplantation may be a treatment option.

The most important part of preventing toxic liver injury is always keeping in mind that external substances such as the medications and foods we consume can all be causes of toxic liver injury. There are almost no drugs known to have "no" liver toxicity at all. Therefore, all medications require careful attention not only to their effectiveness but also to whether side effects occur.

In addition to medications prescribed by a specialist, unnecessary drugs should be avoided, and the indiscriminate use of unprescribed herbal medicine, health functional foods, and folk remedies should be avoided. In particular, since many cases of liver injury caused by plant-based natural products have been reported, plant-based products with uncertain ingredients must be handled with caution.

Frequently Asked Questions from Patients

1. What symptoms occur when toxic liver injury develops?

Toxic liver injury, like most other liver diseases, is usually asymptomatic.

Even when symptoms are present, they are often nonspecific symptoms such as fatigue and loss of appetite, rather than symptoms unique to liver disease. Jaundice and ascites, which are known as characteristic symptoms, only appear when liver injury becomes very severe. Therefore, it is extremely difficult to recognize liver injury based on symptoms alone.

2. Can toxic liver injury occur even when taking medicine prescribed by a doctor?

Yes, that is correct. All medicines have both therapeutic effects and side effects. Also, it should be understood that there are almost no drugs that do not cause toxic liver injury at all. Doctors pay attention not only to whether a drug is effective when prescribing it, but also to its side effects. This is especially true when prescribing drugs known to cause toxic liver injury not infrequently.

For example, when a person has tuberculosis and is prescribed tuberculosis medication, the doctor checks whether the tuberculosis is improving, but also carefully monitors for side effects from the tuberculosis drugs, including toxic liver injury. Other examples include oral antifungal medications and neuropsychiatric medications.

When a doctor prescribes a medication, they consider whether the drug is truly necessary and whether giving it is the best option in the current situation. Only when they judge that the risk of side effects is far lower than the benefit the patient can obtain do they prescribe it. Even so, undesired toxic liver injury may still occur.

3. Can toxic liver injury occur even when a person with liver disease takes something they believe will help treat the liver disease?

Yes. Unfortunately, such cases are not rare. It is known that in patients who already have liver disease, the frequency of toxic liver injury is higher than in the general population, and serious complications occur more often. There are many cases in which herbal medicine, health functional foods, and folk remedies bought by children for their parents out of concern for their liver disease, and with the good intention of helping with treatment, actually make the liver disease worse. We now need to quickly abandon this dangerous and ignorant practice of "giving medicine as a gift." If you have liver disease, you must consult a specialist and take the prescribed medication only when necessary.

So far, we have explained everything from the symptoms to the treatment of toxic liver injury.

In the next installment, we will learn about hypertension.

Source: Korea Centers for Disease Control and Prevention National Health Information Portal