Preface

The liver is an essential organ with important roles in metabolism, digestion, and immunity. When the liver is too injured and its role cannot be fulfilled at a minimum required level, liver failure occurs and all aforementioned processes are disturbed with a negative impact on patients. This stage is associated with important morbidity, and mortality, and has limited therapeutical resources; sometimes liver transplant is the only remaining option. Therefore, every potentially harmful agent for the liver must be avoided.

However, some of these agents are deliberately recommended for their therapeutic benefit in certain diseases and liver injury occurs as an adverse effect, which makes it difficult for the prescribing physician. The medical option must be clearly explained to patients who must understand why the treatment is important and that the drugs may have an unwanted secondary effect on the liver. Some patients are diagnosed with an incurable disease and the only role of the drug is to prolong survival for an unknown variable period. For these patients, the possibility that a liver injury can occur during therapy may influence their decision to give consent because it is hard to admit that a treatment indicated to reduce the harmful impact of one disease can lead to the appearance of a new disease. In these cases, the risks and benefits of the potential hepatotoxic therapeutical agents must be carefully analyzed by one or more experienced physicians and a decision individualized to the patient must be made.

Multiple medical specialties, especially oncology, rheumatology, and gastroenterology, use therapeutic regimens that may contain agents that can have negative repercussions on liver functions. As such, this book provides comprehensive information on hepatotoxicity with the common purpose of better understanding the liver injury that can occur due to certain drugs prescribed for multiple health problems. Chapters present the latest data in terms of epidemiology, pathogenesis, clinical manifestations, diagnostic methods, and treatment options for the topics addressed in this book.

This book is a useful resource for treating physicians across various specialties as well as physicians in training.

> **Costin-Teodor Streba, Ion Rogoveanu and Cristin Constantin Vere** University of Medicine and Pharmacy of Craiova, Craiova, Romania

**1**

Section 1

Hepatotoxicity Induced

by Drugs

Section 1
