Medikamenten- und fremdstoffbedingte Hepatotoxizität

Zusammenfassung

Die Leber ist das zentrale Organ des Fremdstoffmetabolismus. Leberschäden durch chemische Stoffe aus unserer natürlichen, häuslichen und industriellen Umwelt oder durch Medikamente sind daher häufig. Sie werden jedoch oft verkannt und falsch behandelt. Epidemiologische Daten zeigen, dass insbesondere die medikamenteninduzierten Leberschäden mit der ansteigenden Zahl der jährlich neu entwickelten und vermarkteten Medikamente zunehmen. Bei der fremdstoffinduzierten Leberschädigung werden akut verlaufende Formen von chronischen Leberschädigungen unterschieden. Ein Hepatitis-ähnliches Bild wird ebenso beobachtet wie cholestatische Formen. Außerdem kann das Bild der Leberschädigung von zusätzlichen Symptomen der Hypersensitivitätsreaktion gegenüber Fremdstoffen oder Medikamenten begleitet werden. Fremdstoffbedingte Schädigungen des Gefäßsystems der Leber werden ebenso beobachtet wie das Entstehen von Lebertumoren und die Entwicklung einer Leberzirrhose. Erste Voraussetzung der Behandlung von Leberschäden durch Fremdstoffe ist zunächst die korrekte Diagnose. Hierbei spielt die umfassende Expositionsanamnese eine entscheidende Rolle. Im Weiteren sollte die Diagnose durch zusätzliche diagnostische Schritte und durch die Beobachtung des Verlaufes der Erkrankung nach Absetzen oder Elimination des Medikamentes oder Fremdstoffes erhärtet werden. Eine gezielte Therapie ist selten möglich. Das Hauptziel muss daher die Prävention bleibender Schäden durch eine frühzeitige Diagnose sein. Bei der Vielfalt der leberschädigenden Fremdstoffe und Medikamente ist dieses Kapitel der Inneren Medizin für den behandelnden Arzt eine große Herausforderung.

Abstract

The liver is essential for metabolism of drugs and exogenous toxins. Therefore, liver toxicity due to natural, domestic and industrial toxins or drugs is common but rarely recognised. Although thorough epidemiological data are missing, the number of cases with drug-induced liver toxicity is increasing, parallel to the growing number of drugs.

Adverse hepatic reactions may present as acute or chronic liver damage. Independent from the cause and mechanism of liver damage, the clinical presentation may be either cytolytic or cholestatic. In addition, liver damage may be accompanied by a systemic hypersensitivity reaction against the applied agent. Drug- or toxin-induced liver damage includes vascular damage, induction of liver tumours and development of liver cirrhosis.

The prerequisite for specialised treatment of drug-induced adverse hepatic reactions is establishing the diagnosis which is obtained by a thorough medical history taken by an experienced physician with a special emphasis on drug or toxin exposure. The diagnosis may be confirmed by additional diagnostic measures (e. g. liver biopsy) or the clinical course after exposure to the causing agent has been stopped. Only in a minority of cases a definite treatment may be available. Therefore, the main aim is to prevent chronic liver damage through early and correct diagnosis. Due to the extensive variety of possibly liver toxic drugs and chemical agents this aspect is a major challenge to physicians.

Schlüsselwörter

Fremdstoffe - Hepatotoxizität - Medikamente - Hepatitis

Key words

Toxins - hepatotoxicity - liver - hepatitis

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