By: Gh. Pouryaghoub. MD Center for Research on Occupational Diseases

(CROD) Tehran University of Medical Sciences (TUMS)

Chemically Induced Liver Disorders Inflammatory Liver Disorders Disorders Induced By Physical Agents Malignant Liver Diseases

Non-specific May be secondary important Chronic or Acute Limitation of detection Multiple exposure

Category of AgentIncidenceExperimental ReproducibilityDose DependentExample

Intrinsic toxin

Direct HighYesYesCarbon tetrachloride

Indirect

Cytotoxic HighYesYesDimethylnitrosamine

CholestaticHighYesYesMethylenedianiline

Host idiosyncrasy

Hypersensitivity LowNoNoPhenytoin

Metabolic abnormalityLowNoNoIsoniazid

Solvents Carbon Tetrachloride And Other chlorinated SolventDimethylformamide TolueneOther Solvents Mixed Solvent Halothane And Other Anesthetic Solvents

Pesticides (And Related Halogenated Hydrocarbons)

MetalsArsenicLead

Clinical History medical historyoccupational historyexposure history

Physical Examination Laboratory Evaluation

serum marker of hepatobiliary diseaseALT-ASTAP-GGT

biochemical tests of liver functionclearance teststest of hepatic metabolismtest of hepatic synthetic function

Anatomic Tests Liver Biopsy

AgentOccupation

Hepatitis A virusNursery and kindergarten staffSewer workers

Hepatitis B and C viruses Health care workers with blood and body fluid contact

CytomegalovirusPediatric health care workers

Coxiella burnetiiAnimal care workersFarm workersSlaughterhouse workers

Leptospira icterohaemorrhagiaeSewer workerFarm workers

Surveillance Strategies Screening Tests

Clinical Management Of Abnormal Liver Function Tests