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Occupational liver disease
Guidelines
Key sources
The following summarized guidelines for the evaluation and management of occupational liver disease are prepared by our editorial team based on guidelines from the European Association for the Study of the Liver (EASL 2020).
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Screening and diagnosis
Indications for screening: as per EASL 2020 guidelines, consider ultrasound surveillance for the development of liver neoplasms in workers exposed to high levels of vinyl chloride monomer in the past, that is until the mid-1970s, as defined by their job title (reactor cleaners).
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Screening for fatty liver
Diagnosis
Classification and risk stratification
Severity grading
As per EASL 2020 guidelines:
Consider the adapted severity index scale designed for drug-induced liver injury for the evaluation of severity of acute chemical liver injury.
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Consider dynamic evaluation, including repeated liver tests and liver stiffness measurements by transient elastography or serum predictors of fibrosis such as Fib-4 and AST to platelet ratio index, for staging of occupational liver disease after the patient is removed from occupational exposure to suspected toxins.
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Diagnostic procedures
Liver biopsy
As per EASL 2020 guidelines:
Consider liver biopsy in patients with persistently abnormal noninvasive liver tests, depending on the clinical context and the extent of the liver abnormalities.
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Consider sampling of the non-tumoral liver when performing a liver biopsy to diagnose a liver mass.
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