The liver processes almost everything a person consumes, including chemicals, medications and alcohol. In some instances, these substances may cause serious injury to the liver, resulting in toxic hepatitis — a condition that causes inflammation of the liver.
Many medications have the potential to cause liver toxicity and carry a warning on their label to this effect. In most cases when problems occur, they are mild and only apparent from blood tests, and can be resolved by reducing the dose of medication or discontinuing use.
In rare instances, however, some patients have an idiosyncratic reaction to a drug, causing massive destruction of liver cells and rapidly developing liver failure. Patients experiencing a severe idiosyncratic drug reaction must stop taking the drug immediately. They also require an urgent referral to a transplant center for a liver transplant, which may be life-saving.
Despite their widespread availability, some herbs and nutritional supplements may cause toxic hepatitis. It is important to note that these substances are not subject to the same regulations, testing or approval processes as conventional drugs. Studies have shown that some herbs and nutritional supplements are adulterated with steroids or antibiotics.
Herbs that may be toxic to the liver include comfrey, chaparral, germander, kava, valerian, mistletoe and traditional Chinese herbs. People with liver disease should not use herbs or nutritional supplements without the approval of their doctor.
Alcohol abuse is well known to cause liver damage, but the extent of injury varies widely among people who drink to excess. In individuals who are prone to alcohol-related liver injury — possibly due to genetics — heavy drinking can result in acute liver failure, a life-threatening condition that requires hospitalization and intensive care. Other people may develop progressive liver disease from regular, heavy use of alcohol.
The goal of treatment is to eliminate alcohol from the diet and treat the psychological dependence on alcohol. Even at the advanced stage of cirrhosis, liver disease from alcohol may show significant improvement with total abstinence from alcohol.
Signs and symptoms of toxic hepatitis vary, depending on the cause. However, some of the more common include:
In making a diagnosis of toxic hepatitis, your doctor will ask about your medical history, including detailed information regarding your medications, use of herbs or other over-the-counter nutritional supplements and alcohol consumption. Your doctor also will carry out a thorough physical exam, which can be helpful in determining the presence or absence of significant chronic liver disease.
The following tests may be performed to assess the presence and severity of liver damage:
The first and most important step in treating toxic hepatitis is to identify and eliminate the substance that is causing the problem, such as medications, herbs or alcohol. In the case of alcohol-related liver damage, joining a treatment program such as Alcoholics Anonymous is highly recommended. Alcoholism is a serious addiction and without the proper treatment and support networks, many people experience a relapse and return to alcohol.
Urgent liver transplantation should be considered for patients with life-threatening liver damage caused by a medication, herb or nutritional supplement.
Patients with end-stage cirrhosis from alcohol may be considered for transplantation. However, they are considered candidates for transplantation only if they have been completely abstinent from alcohol and in a treatment program for a minimum of six months.
Reviewed by health care specialists at UCSF Medical Center.