Hepatotoxic Effects of Workplace Exposure

Chemicals Associated With Liver Diseases 1) Haloalkanes:- a) Carbon Tetra Chloride b) Tetra Chloro Ethane c) Tri Chloro Methane (Chloroform) d) Tetra Chloro Ethylene e) Toluene
2) Nitro Paraffins:a) Nitro Methane b) Nitro Ethane c) Nitro Propane a) Di Nitro Toluene b) Nitro Benzene a) Copper b) Arsine & Arsenic c) Beryllium d) Yellow Phosphorus e) Cadmium f) Selenium g) Chromium h) Mercury i) Nickel

3) Nitro Aromatics:4) Metals & Metalloids:-

5) 6) 7) 8)

Pesticides & Herbisides Poly Chlorinated Biphenyls (PCBs) Vinyl Chloride Phthalate Esters

Investigations:- Non Invasive Screening:I) History:1) Workplace or Environmental Exposure 2) Alcohol or Drug Ingestion 3) Previous Medical History These 3 points will give history of Hepatitis or Jaundice 4) Family History:- Needed for Autoimmune Disorders. II) Ultrasonography:1) Chronic Liver Disease 2) Extra Hepatic Biliary obstruction. 3) Infiltration 4) Venous Abnormalities 5) Tumour All these are for Portal Hypertension or Portal or Hepatic Vein Obstruction. III) Immunology:- 1) Smooth Muscle Antibodies 2) Antinuclear Factor:- Autoimmune Hepatitis Type I 3) Liver, Kidney Microsomal Antibodies:- Autoimmune Hepatitis Type II 4) Anti mitochondrial Antibodies:- For Primary Biliary Cirrhisis IV) Biochemistry:- 1) Serum Iron, Ferritin for Hemochromatosis. 2) Iron Binding Capacity 3) Serum Ceruloplasmin for Wilsons Disease 4) Antitrypsin for Antitrypsin deficiency 5) Fetoprotein for Hepatoma

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Viral Screening:-

1) Hepatitis A Antibodies IgM:- Acute Type A Hepatitis 2) Hepatitis B Anitibodies:- HBS Ag. Both for Acute 3) HB Code Antibodies, IgM Type B Hepatitis 4) HB Code Antibodies IgG :- Chronic Type B Hepatitis 5) HCV Antibodies :- For Hepatitis C 6) HCV-RNA:- For Type 2 Hepatitis.

Disorders Produce Abnormal Liver Function Tests:I) Alkaline Phosphatase Isoenzymes :1) Bone Type 2) Liver Type 1) Bone Type:- Mainly for A) Pagets Disease & 2) Osteomalesia 2) Liver Type:- a) Infiltration b) Cholestasis:- Intrahepatic or Extra hepatic II) Aspartate Transaminase (AST) for Hepatitis both Acute & Chronic III) GgTP (Gamma Glutamic Trans Peptidase:- Microsomal enzyme induction can be done by A) Drugs & Chemicals 3) Cholestasis 4) Infiltration 5) Non Hepatic Disease IV) BilirubinI: Indirect Reacting:- a) Gilberts Syndrome b) Haemolysis V) Bilirubin II:- Direct Reacting =These 3 has best Prognostic Significance in VI) Disease 1) Acute Liver 2) Chronic hepatic Cirrhosis VII) Prothrombin Time VIII) Albumin Treatment of Occupational Liver Disease (Treatment if Liver is Damaged by some Agent) 1) Specific Therapy:a) Arsenic:- DiMerCaprol. b) Copper:- Penicillamine c) Carbon Tetra Chloride:- Prostacyclines d) Porphyria due to Dioxine:- Chloroquin e) Chlorodicone:- Antidote Chlostyramine 2) Non-Specific Therapy Fulminating or Acute Liver Failure 1) Coagulopathy:- Fresh Frozen Plasma 2) Encephalopathy:- Lactulose, Neomycin 3) Cerebral Oedema:- Mannitol 4) Renal Failure:- Dialysis, Hemofiltration 5) Glutathione Depletion:- N Acityl Cysteine 6) Fulminant Hepatic Failure:- Liver Transplant

Chronic 1) Ascites:- Diuretics, Paracentesis 2) Verises:- a) Sclerotherapy b) Banding c) Beta Blockers 3) Cholestatis:- Uro Deoxy Cholic Acid 4) Fibrosis:- Colchisin 5) End Stage Cirrhosis:- Liver Transplant