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Erschienen in:
15.07.2019 | Drug-Induced Liver Injury (P Hayashi, Section Editor)
Bile Duct Injury Due to Drug-Induced Liver Injury
Erschienen in: Current Hepatology Reports | Ausgabe 3/2019
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Purpose of Review
Drug-induced liver injury (DILI) can present with a variable clinical and pathological phenotype and can be classified using liver enzymes as hepatocellular, cholestatic, or a mixed pattern. The cholestatic pattern has been considered amongst the spectrum of direct liver damage at the microscopic level, but recently, bile duct injury, as a manifestation of DILI, has emerged as a distinct entity, and this review examines several examples of biliary tract abnormalities due to DILI from a clinical, radiologic, and pathologic perspective.
Recent Findings
Case series and reports have emerged over the last few years of drugs causing cholangiographic changes or direct injury to the intra- and extra-hepatic biliary tree, such as ketamine and several chemotherapy agents. The DILI Network (DILIN) in the USA has published their experience of cases with vanishing bile duct syndrome on histology and sclerosing cholangitis-like changes seen on cholangiography. The pathogenesis of these changes is unclear but it appears that this type of injury is more severe and more likely to lead to a chronic injury with increased mortality than other cases of DILI.
Summary
Bile duct injury due to DILI is an increasingly recognized entity and imaging of the biliary tree in conjunction with liver biopsy should be considered in patients with severe cholestatic DILI.