Drug induced liver injury physical examination
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Rachita Navara, M.D. [2]
Overview
Patients with drug induced liver injury usually appear normal on physical exam, unless they are presenting in acute liver failure.[1] Some patients may also present in chronic liver failure due to rare drugs associated with liver scarring, e.g. methotrexate.[2]
Physical Examination
General Appearance
The general appearance of the patient will depend on the severity of the condition.
Vital Signs
The patient may be febrile.
Skin
The skin may be jaundiced. There may also be excoriations from pruritis due to drug induced cholestatic injury.
Abdomen
There may be right upper quadrant tenderness. There may be ascites in cases of chronic drug induced liver injury.
Extremities
There may be stigmata of chronic drug induced liver injury including cachexia, spider angiomata, and palmar erythema.
References
- ↑ Davern TJ (2012). "Drug-induced liver disease". Clin Liver Dis. 16 (2): 231–45. doi:10.1016/j.cld.2012.03.002. PMID 22541696.
- ↑ Fries JF, Ramey DR, Singh G (1994). "Suggested guidelines for monitoring liver toxicity in rheumatoid arthritis patients treated with methotrexate: comment on the article by Kremer et al". Arthritis Rheum. 37 (12): 1829–30. PMID 7986233.