A liver biopsy is a procedure to remove a small sample of liver tissue for laboratory testing. A liver biopsy is commonly performed by inserting a thin needle through your skin and into your liver.
Tests and procedures used to diagnose toxic hepatitis include:
- Physical exam. Your doctor will likely perform a physical exam and take a medical history. Be sure to bring to your appointment all medications you're taking, including over-the-counter drugs and herbs, in their original containers. Tell your doctor if you work with industrial chemicals or may have been exposed to pesticides, herbicides or other environmental toxins.
- Blood tests. Your doctor may order blood tests that look for high levels of certain liver enzymes. These enzyme levels can show how well your liver is functioning.
- Imaging tests. Your doctor may recommend an imaging test to create a picture of your liver using ultrasound, computerized tomography (CT) or magnetic resonance imaging (MRI). Additional imaging tests may include magnetic elastography and transient elastography.
- Liver biopsy. A liver biopsy can help confirm the diagnosis of toxic hepatitis and help exclude other causes. During a liver biopsy, a needle is used to extract a small sample of tissue from your liver. The sample is examined under a microscope.
Doctors will work to determine what's causing your liver damage. Sometimes it's clear what's causing your symptoms, and other times it takes more detective work to pinpoint a cause. In most cases, stopping exposure to the toxin causing liver inflammation will reduce the signs and symptoms you experience.
Treatments for toxic hepatitis may include:
- Supportive care. People with severe symptoms are likely to receive supportive therapy in the hospital, including intravenous fluids and medication to relieve nausea and vomiting. Your doctor will also monitor for liver damage.
- Medication to reverse liver damage caused by acetaminophen. If your liver damage was caused by an overdose of acetaminophen, you'll receive a chemical called acetylcysteine right away. The sooner this medication is administered, the greater the chance of limiting liver damage. It's most effective if administered within 16 hours of the acetaminophen overdose.
- Emergency care. For people who overdose on a toxic medication, emergency care is essential. People who overdose on certain medications other than acetaminophen may benefit from treatments to remove the offending medication from the body or reduce its toxic effect.
Liver transplant. When liver function is severely impaired, a liver transplant may be the only option for some people. A liver transplant is an operation to remove your diseased liver and replace it with a healthy liver from a donor.
Most livers used in liver transplants come from deceased donors. In some cases, livers can come from living donors who donate a portion of their livers.
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Preparing for your appointment
Make an appointment with your family doctor or a general practitioner if you have any signs or symptoms that worry you. If you're thought to have a liver problem, such as toxic hepatitis, you'll likely be referred to a liver specialist (hepatologist).
Because appointments can be brief, and because there's often a lot to cover, it's a good idea to be well-prepared. Here's some information to help you get ready and know what to expect from your doctor.
What you can do
- Be aware of any pre-appointment restrictions. At the time you make the appointment, be sure to ask if there's anything you need to do in advance, such as restrict your diet.
- Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
- Write down key personal information, including any major stresses or recent life changes.
- Make a list of all medications, vitamins or supplements that you're taking.
- Take a family member or friend along. Sometimes it can be difficult to remember all the information provided during an appointment. Someone who accompanies you may remember something that you missed or forgot.
- Write down questions to ask your doctor.
For toxic hepatitis, some basic questions to ask your doctor include:
- What is likely causing my symptoms or condition?
- Are there other possible causes for my symptoms or condition?
- Could one of the medications I'm taking be responsible for the damage to my liver?
- Is my liver damaged?
- What kinds of tests do I need?
- Is my condition likely temporary or chronic?
- What is the best course of action?
- What are the alternatives to the primary approach that you're suggesting?
- I have other health conditions. Will these conditions or their treatment affect the outcome of toxic hepatitis? How can I best manage them together?
- Are there any restrictions that I need to follow?
- Should I see a specialist? What will that cost, and will my insurance cover it?
- Is there a generic alternative to the medicine you're prescribing me?
- Are there brochures or other printed material that I can take with me? What websites do you recommend?
- What will determine whether I should plan for a follow-up visit?
In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment at any time.
What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may allow more time to cover points you want to address. Your doctor may ask:
- When did you begin experiencing symptoms?
- Have your symptoms been continuous or occasional?
- How severe are your symptoms?
- What, if anything, seems to improve your symptoms?
- What, if anything, appears to worsen your symptoms?
- What prescription and over-the-counter medications are you taking, and have you started any new medications recently?
- Do you take acetaminophen?
- Do you take herbal or nutritional supplements?
- How much alcohol do you drink and how often?
- Have you noticed yellowing in the whites of your eyes?
- Has your urine color appeared darker?
- Does anyone in your family have a history of liver disease?
June 04, 2022
- Andrade RJ, et al. EASL Clinical Practice Guidelines: Drug-induced liver injury. Journal of Hepatology. In press. April 24, 2019.
- Burt AD, et al, eds. Drugs and toxins. In: MacSween's Pathology of the Liver. 7th ed. Philadelphia, Pa.: Elsevier; 2018. https://www.clinicalkey.com. Accessed April 24, 2019.
- Liver injury caused by drugs. Merck Manual Professional Version. https://www.merckmanuals.com/professional/hepatic-and-biliary-disorders/drugs-and-the-liver/liver-injury-caused-by-drugs?query=liver%20injury. Accessed May 4, 2021.
- Larson AM. Drug-induced liver injury. https://www.uptodate.com/contents/search. Accessed May 4, 2021.
- Yeo CJ. Laboratory measurement of hepatic function. In: Shackelford's Surgery of the Alimentary Tract. 8th ed. Philadelphia, Pa.: Elsevier; 2019. https://www.clinicalkey.com. Accessed April 24, 2019.
- Acetaminophen poisoning. Merck Manual Professional Version. https://www.merckmanuals.com/professional/injuries-poisoning/poisoning/acetaminophen-poisoning. Accessed May 4, 2021.
- Nader R. Liver disease. In: Tietz Textbook of Clinical Chemistry and Molecular Diagnostics. 6th ed. Philadelphia, Pa.: Elsevier; 2018. https://www.clinicalkey.com. Accessed April 24, 2019.
- Picco MF (expert opinion). Mayo Clinic, Jacksonville, Fla. June 26, 2019.
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