Open AccessDrug-induced liver injury and liver injury during pregnancy: pathogenesis, diagnosis and treatment
Author(s) -
Ya. S. Tsymmerman,
Л. Г. Вологжанина
Publication year - 2020
Publication title -
vestnik kluba pankreatologov
Language(s) - English
Resource type - Journals
ISSN - 2077-5067
DOI - 10.33149/vkp.2020.01.06
Subject(s) - medicine , liver injury , ursodeoxycholic acid , autoimmune hepatitis , pregnancy , gastroenterology , liver disease , hepatitis , pathogenesis , cholestasis , drug , cholestasis of pregnancy , cirrhosis , pharmacology , fetus , biology , genetics
This article is a literature review on drug-induced liver injury (DILI). The authors revealed the role of liver tissue in biotransformation of drugs, and the mechanisms of hepatocytes injury under the influence of their metabolites (direct lesion of hepatocytes structure and idiosyncratic hypersensitivity). Separation of drugs into true and facultative hepatotoxins is explained. Opinion of patients and doctors of various majors about the most hepatotoxic drugs is presented. DILI classification depending on the dominant pathogenetic mechanism is given. Nuances of clinical and laboratory diagnostics and drug treatment of DILI are revealed. Advantages of ademetionine, ursodeoxycholic acid and glucocorticoids prescription are analyzed, indications for their application are listed, and the optimal therapeutic dosages of these drugs are given. Expediency of prescribing plant hepatoprotector chophytol and myotropic spasmolytic hymecromone is considered.
Pathogenesis of liver injury during pregnancy is described, occurrence of hepatological pathology in this cohort of patients is briefly characterized, nuances of diagnostics and course of intrahepatic cholestasis of pregnancy, acute fatty liver dystrophy of pregnancy, HELLP-syndrome are considered. Peculiarities of the course of pregnancy on the background of the previous liver disease (viral hepatitis A, B, C, autoimmune hepatitis, primary biliary cirrhosis, Wilson’s disease) are revealed. The most effective conservative (ademetionine, ursodeoxycholic acid) and operative techniques (early delivery) of correction of liver injury of pregnancy are listed.