Review
Copyright ©2013 Baishideng Publishing Group Co.
World J Gastroenterol. May 21, 2013; 19(19): 2864-2882
Published online May 21, 2013. doi: 10.3748/wjg.v19.i19.2864
Table 2 Check list for herb induced liver injury diagnosis
Items to be assessedInformation obtained
YesNoPartial
Brand name with batch number and expiration date
Indication of herbal use
Dates of symptoms leading to herbal treatment
Daily dose
Application form of herbal product
Exact date of herb start
Exact date of herb end
Accurate dates of emerging new symptoms after herb start in chronological order
Accurate date of initially increased liver values
Time frame of challenge
Time frame of latency period
Time frame of dechallenge
Verification of temporal association
Exclusion of temporal association
Gender, age, body weight, height, BMI
Ethnicity, profession
Past medical history and actual assessment regarding preexisting general diseases
Past medical history and actual assessment regarding preexisting liver diseases
Risk factors such as age and alcohol
Quantification of alcohol and drug use
Comedicated synthetic drugs, herbal drugs, herbal and other dietary supplements with all details of product, daily dose, exact dates of start and end of use, indication
ALT value initially including exact date and normal range
ALT values during dechallenge at least on days 8 and 30, and later on, with exact dates
ALT values during dechallenge to exclude a second peak, with exact dates
ALT normalization with exact date and actual value
ALP value initially including exact date and normal range
ALP values during dechallenge up to 180 d, and later on, with exact dates
ALP values during dechallenge to exclude a second peak, with exact dates
ALP normalization with exact date and actual value
AST value initially including normal range
Laboratory criteria for definition of hepatotoxicity
Laboratory criteria for injury pattern
Liver and biliary tract imaging including hepatobiliary sonography, CT, MRT, MRC
Color Doppler sonography of liver vessels
Unintended reexposure
Known hepatotoxicity caused by the herb
Consideration and exclusion of other possible causes
Hepatitis A
Anti-HAV-IgM
Hepatitis B
HBsAg, anti-HBc-IgM, HBV-DNA
Hepatitis C
Anti-HCV, HCV-RNA
Hepatitis E
Anti-HEV-IgM, anti-HEV-IgG, HEV-RNA
CMV
CMV-PCR, titer change for anti-CMV-IgM and anti-CMV-IgG
EBV
EBV-PCR, titer change for anti-EBV-IgM and anti-EBV-IgG
HSV
HSV-PCR, titer change for anti-HSV-IgM and anti-HSV- IgG
VZV
VZV-PCR, titer change for anti-VZV-IgM and anti-VZV-IgG
Other virus infections
Specific serology of Adenovirus, Coxsackie-B-virus, Echovirus, Measles virus, Rubella virus, Flavivirus, Arenavirus, Filovirus, Parvovirus, HIV, and others
Other infectious diseases
Specific assessment of bacteria, fungi, parasites, worms, and others
AIH type I
Gamma globulins, ANA, SMA, AAA, SLA/LP, anti-LSP, anti-ASGPR
AIH type II
Gamma globulins, anti-LKM-1 (CYP 2D6), anti-LKM-2 (CYP 2C9), anti-LKM-3
PBC
AMA, anti-PDH-E2
PSC
p-ANCA, MRC
AIC
ANA, SMA
Overlap syndromes
See AIH, PBC, PSC, and AIC
NASH
BMI, insulin resistance, hepatomegaly, echogenicity of the liver
ALD
Patient’s history, clinical and laboratory assessment, sonography
DILI
Patient’s history, clinical and laboratory assessment, sonography, use of the CIOMS scale
Cocaine, ecstasy and other amphetamines
Toxin screening
Rare intoxications
Toxin screening for household and occupational toxins
Hereditary hemochromatosis
Serum ferritin, total iron-binding capacity, genotyping for C2824 and H63D mutation, hepatic iron content
Wilson’s disease
Copper excretion (24 h urine), ceruloplasmin in serum, free copper in serum, Coombs-negative hemolytic anemia, hepatic copper content, Kayser-Fleischer-Ring, neurologic-psychiatric work-up, genotyping
Porphyria
Porphobilinogen in urine, total porphyrines in urine
α1-Antitrypsin deficiency
α1-Antitrypsin in serum
Biliary diseases
Clinical and laboratory assessment, hepatobiliary sonography, endosonography, CT, MRT, MRC
Pancreatic diseases
Clinical and laboratory assessment, sonography, CT, MRT
Celiac disease
TTG antibodies, endomysium antibodies, duodenal biopsy
Anorexia nervosa
Clinical context
Parenteral nutrition
Clinical context
Cardiopulmonary diseases with shock liver (cardiac hepatopathy, ischemic hepatitis)
Cardiopulmonary assessment of congestive heart disease, myocardial infarction, cardiomyopathy, cardiac valvular dysfunction, pulmonary embolism, pericardial diseases, arrhythmia, hemorrhagic shock, and various other conditions
Addison’s disease
Plasma cortisol
Thyroid diseases
TSH basal, T4, T3
Grand mal seizures
Clinical context of epileptic seizure (duration > 30 min)
Heat stroke
Shock, hyperthermia
Polytrauma
Shock, liver injury
Systemic diseases
Specific assessment of M. Boeck, amyloidosis, lymphoma, other malignant tumors, sepsis and others
Other diseases
Clinical context