Selected topics related to occupational exposures - Part IV. Occupational liver disease

Occupational and environmental substances associated with liver injury incl ude industrial chemicals, drugs, certain bacterial and viral infections, an d other physical agents. Hepatotoxic chemical agents can be classified as d irect hepatotoxins, indirect hepatotoxins, or agents that cause liver injur y as a result of host idiosyncrasy. More than 100 industrial chemicals have been shown to be acutely hepatotoxic. Occupations with hepatotoxin exposur es are numerous and include farm workers, chemists, dry cleaners, electropl aters, garage workers, health care workers, nurses, painters, printers, ray on makers, and others. Clinical presentation of occupational liver disease may be acute/subacute or chronic but is often insidious. Some hepatotoxins are capable of causing malignancy. The key to diagnosis of occupational liver disease is exposure history. The occupational and environmental history should include a brief description of the patient's current and recent jobs to the extent necessary to assess their potential for workplace hepatotoxic exposures. Confounders such as ob esity, alcohol, and viral hepatitis are common, and a careful history and e xamination are essential. A variety of tests are used to evaluate liver dis ease and may include serum markers, tests of synthetic liver function, clea rance tests, and anatomic tests. A key responsibility of the primary care provider is to prevent further liv er injury from preventable occupational exposures; not only the patient but also coworkers may be at risk. Efforts should be made to ensure that patie nts with potential hepatotoxic exposures are working or living in safe cond itions. Collaboration with an occupational specialist may be especially use ful in this regard.