{"id":5089,"date":"2023-03-30T06:30:00","date_gmt":"2023-03-30T09:30:00","guid":{"rendered":"https:\/\/gastropedia.pub\/pt\/?p=5089"},"modified":"2023-03-31T11:52:23","modified_gmt":"2023-03-31T14:52:23","slug":"investigacao-de-hepatite-medicamentosa","status":"publish","type":"post","link":"https:\/\/gastropedia.pub\/pt\/gastroenterologia\/figado\/investigacao-de-hepatite-medicamentosa\/","title":{"rendered":"Investiga\u00e7\u00e3o de Hepatite Medicamentosa (Drug-Induced Liver Injury &#8211; DILI): principais conceitos e linha de racioc\u00ednio"},"content":{"rendered":"<div class=\"pdfprnt-buttons pdfprnt-buttons-post pdfprnt-top-right\"><a href=\"https:\/\/gastropedia.pub\/pt\/wp-json\/wp\/v2\/posts\/5089?print=pdf\" class=\"pdfprnt-button pdfprnt-button-pdf\" target=\"_blank\" ><img decoding=\"async\" src=\"https:\/\/gastropedia.pub\/pt\/wp-content\/plugins\/pdf-print\/images\/pdf.png\" alt=\"image_pdf\" title=\"Ver PDF\" \/><\/a><a href=\"https:\/\/gastropedia.pub\/pt\/wp-json\/wp\/v2\/posts\/5089?print=print\" class=\"pdfprnt-button pdfprnt-button-print\" target=\"_blank\" ><img decoding=\"async\" src=\"https:\/\/gastropedia.pub\/pt\/wp-content\/plugins\/pdf-print\/images\/print.png\" alt=\"image_print\" title=\"Conte\u00fado de impress\u00e3o\" \/><\/a><\/div>\r\n<h2 class=\"wp-block-heading\"><strong>Aspectos Gerais<\/strong><\/h2>\r\n\r\n\r\n\r\n<p>A hepatite medicamentosa <em>(Drug-induced liver injury, DILI) <\/em>\u00e9 um dos quadros mais desafiadores na Hepatologia devido a ampla disponibilidade de medica\u00e7\u00f5es, suplementos e ervas com potencial de hepatoxicidade heterog\u00eaneo, variando desde leve eleva\u00e7\u00e3o de enzimas hep\u00e1ticas at\u00e9 hepatite aguda pronunciada e insufici\u00eancia hep\u00e1tica fulminante (IHF).<\/p>\r\n\r\n\r\n\r\n<p>Tradicionalmente, <em>DILI<\/em> pode ser classificada como intr\u00ednseca (ou direta) <em>versus<\/em> idiossincr\u00e1sica. A primeira \u00e9 tipicamente dose-relacionada e ocorre na maioria dos pacientes expostos a uma droga, ocorrendo dentro de um curto espa\u00e7o de tempo (horas a dias). J\u00e1 <em>DILI<\/em> idiossincr\u00e1sica usualmente n\u00e3o \u00e9 dose-dependente, ocorre em uma menor propor\u00e7\u00e3o de indiv\u00edduos expostos (imprevis\u00edvel) e apresenta uma lat\u00eancia vari\u00e1vel entre dias a semanas.\u00a0<\/p>\r\n\r\n\r\n\r\n<p>Um pr\u00e9-requisito comum para <em>DILI<\/em> intr\u00ednseca e idiossincr\u00e1sica \u00e9 o metabolismo de drogas lipof\u00edlicas no f\u00edgado, gerando metab\u00f3litos reativos que levam \u00e0 liga\u00e7\u00e3o covalente, estresse oxidativo mitocondrial e do ret\u00edculo endoplasm\u00e1tico. Tais consequ\u00eancias podem resultar (a) diretamente em necrose ou apoptose [intr\u00ednseca] ou (b) em resposta imune adaptativa [idiossincr\u00e1sica] em indiv\u00edduos geneticamente suscept\u00edveis.\u00a0As principais drogas relacionadas com <em>DILI<\/em> est\u00e3o na Tabela 1.<\/p>\r\n\r\n\r\n<div class=\"wp-block-image\">\r\n<figure class=\"aligncenter size-full\"><img fetchpriority=\"high\" decoding=\"async\" width=\"589\" height=\"286\" class=\"wp-image-5091\" src=\"https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2023\/03\/image-1.png\" alt=\"\" srcset=\"https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2023\/03\/image-1.png 589w, https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2023\/03\/image-1-300x146.png 300w, https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2023\/03\/image-1-585x284.png 585w\" sizes=\"(max-width: 589px) 100vw, 589px\" \/>\r\n<figcaption class=\"wp-element-caption\"><strong>Tabela 1. Drogas associadas com <em>DILI<\/em> intr\u00ednseca e idiossincr\u00e1sica<\/strong><\/figcaption>\r\n<\/figure>\r\n<\/div>\r\n\r\n\r\n<h2 class=\"wp-block-heading\"><strong>Padr\u00f5es de DILI<\/strong><\/h2>\r\n\r\n\r\n\r\n<p>Existem 3 padr\u00f5es de <em>DILI<\/em> avaliados pela eleva\u00e7\u00e3o de enzimas hep\u00e1ticas:<\/p>\r\n\r\n\r\n\r\n<ul class=\"wp-block-list\">\r\n<li><strong>Hepatocelular<\/strong>:\u00a0 se ALT isolada \u2265 5x limite superior da normalidade (LSN)\u00a0 ou\u00a0 Fator R \u2265 5<\/li>\r\n\r\n\r\n\r\n<li><strong>Colest\u00e1tico<\/strong>: se FA isolada \u2265 2x LSN\u00a0 ou\u00a0 Fator R \u2264 2<\/li>\r\n\r\n\r\n\r\n<li><strong>Misto: <\/strong>Fator R &gt; 2\u00a0 a\u00a0 &lt; 5<\/li>\r\n<\/ul>\r\n<p><a style=\"text-decoration-line: underline;\" href=\"https:\/\/www.mdcalc.com\/calc\/4064\/r-factor-liver-injury\" target=\"_blank\" rel=\"noopener noopenr\"><img decoding=\"async\" class=\"wp-image-5253 size-full aligncenter\" src=\"https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2023\/03\/R-em-png-1.png\" alt=\"\" width=\"100\" height=\"46\" \/><\/a><\/p>\r\n<p>\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 Clique para calcular<\/p>\r\n\r\n\r\n\r\n<h2 class=\"wp-block-heading\"><strong>Recomenda\u00e7\u00e3o<\/strong><\/h2>\r\n\r\n\r\n\r\n<p class=\"has-background\" style=\"background-color: #d8e0e2;\">DILI deve ser classificada como hepatocelular, colest\u00e1tica ou mista de acordo com o padr\u00e3o de eleva\u00e7\u00e3o de enzimas hep\u00e1ticas da primeira dosagem laboratorial em rela\u00e7\u00e3o ao evento cl\u00ednico. Grau B (EASL, 2019).<\/p>\r\n\r\n\r\n\r\n<h2 class=\"wp-block-heading\"><strong>Ch\u00e1s, Ervas e Fitoter\u00e1picos<\/strong><\/h2>\r\n\r\n\r\n\r\n<p>A hepatotoxicidade por ch\u00e1s, ervas, fitoter\u00e1picos e suplementos est\u00e1 relacionada a diferentes fatores que coexistem: falta de adequada identifica\u00e7\u00e3o da planta, sele\u00e7\u00e3o da parte errada da planta medicinal, armazenamento inadequado modificando o produto nativo, adultera\u00e7\u00e3o durante o processamento e rotulagem incorreta do produto.\u00a0<\/p>\r\n\r\n\r\n\r\n<p>Outro desafio \u00e9 a falta de clareza na real composi\u00e7\u00e3o de prepara\u00e7\u00f5es \u00e0 base de plantas, em especial, de multicompostos. Ressalta-se ainda que um produto fitoter\u00e1pico pode ser contaminado por compostos t\u00f3xicos que levam \u00e0 hepatotoxicidade, como contamina\u00e7\u00e3o por metais pesados, pesticidas, herbicidas ou at\u00e9 mesmo microoganismos.\u00a0<\/p>\r\n\r\n\r\n\r\n<p>Destacam-se alguns fitoter\u00e1picos que possuem n\u00edvel de evid\u00eancia de hepatotoxicidade:<\/p>\r\n\r\n\r\n\r\n<ul class=\"wp-block-list\">\r\n<li>Plantas que cont\u00e9m alcaloides pirrolizid\u00ednicos (esp\u00e9cies <em>Heliotropium, Senecia, Crotalaria, Symphytum <\/em>e<em> Gynura<\/em>)<\/li>\r\n\r\n\r\n\r\n<li>Germander (\u201ccavalinha\u201d)<\/li>\r\n\r\n\r\n\r\n<li>Kava-kava <em>(Piper methysticum)<\/em><\/li>\r\n\r\n\r\n\r\n<li>Ch\u00e1 verde <em>(Camellia sinensis)<\/em><\/li>\r\n\r\n\r\n\r\n<li>Sena <em>(Cassia angustifolia)<\/em><\/li>\r\n\r\n\r\n\r\n<li>Sacaca <em>(Croton cajucara benth)<\/em><\/li>\r\n\r\n\r\n\r\n<li>Chaparral <em>(Larrea tridentata)<\/em><\/li>\r\n\r\n\r\n\r\n<li><em>P<\/em>oejo <em>(Mentha pulegium)<\/em><\/li>\r\n\r\n\r\n\r\n<li><em>C<\/em>\u00e1scara sagrada <em>(Rhamnus purshiana<\/em>)<\/li>\r\n\r\n\r\n\r\n<li>Erva de S\u00e3o Crist\u00f3v\u00e3o <em>(Cimicifuga racemosa<\/em>)<\/li>\r\n\r\n\r\n\r\n<li>Noni <em>(Morinda citrifolia)<\/em>, entre outras<\/li>\r\n<\/ul>\r\n\r\n\r\n\r\n<p>Dentre os suplementos alimentares, destacam-se:<\/p>\r\n\r\n\r\n\r\n<ul class=\"wp-block-list\">\r\n<li>Cont\u00e9m \u00e1cido \u00fasnico (LipoKinetix, UCP-1, OxyElite)<\/li>\r\n\r\n\r\n\r\n<li>Hydroxycut<\/li>\r\n\r\n\r\n\r\n<li>\u00c1cido linenol\u00e9ico<\/li>\r\n\r\n\r\n\r\n<li>Plethoryl (vitamina A e horm\u00f4nios tireoidianos)<\/li>\r\n\r\n\r\n\r\n<li>Ester\u00f3ides anabolizantes androg\u00eanicos<\/li>\r\n<\/ul>\r\n\r\n\r\n\r\n<h2 class=\"wp-block-heading\"><strong>Recomenda\u00e7\u00e3o<\/strong><\/h2>\r\n\r\n\r\n\r\n<p class=\"has-background\" style=\"background-color: #d8e0e2;\">Suplementos alimentares e fitoter\u00e1picos podem ser considerados como potenciais agentes causadores de les\u00e3o hep\u00e1tica. Grau C (EASL, 2019).<\/p>\r\n\r\n\r\n\r\n<h2 class=\"wp-block-heading\"><strong>Causalidade \u2013 Escores<\/strong><\/h2>\r\n\r\n\r\n\r\n<p>Alguns escores podem ser utilizados na avalia\u00e7\u00e3o de causalidade para <em>DILI<\/em>, de forma que os crit\u00e9rios de cronologia (in\u00edcio e suspens\u00e3o da droga), curso da rea\u00e7\u00e3o, fatores de risco, exclus\u00e3o de outras causas, manifesta\u00e7\u00f5es extra-hep\u00e1ticas, reexposi\u00e7\u00e3o, entre outros aspectos, s\u00e3o pontuados e classificados em exclus\u00e3o ou diagn\u00f3stico poss\u00edvel, prov\u00e1vel ou definitivo para <em>DILI<\/em>:<\/p>\r\n\r\n\r\n\r\n<ul class=\"wp-block-list\">\r\n<li>Council for International Organizations of Medical Sciences Scale\/Roussel-Uclaf-Causality-Assessment-Method (CIOMS\/RUCAM);<\/li>\r\n\r\n\r\n\r\n<li>Clinical Diagnostic Scale\/Maria and Victorino Scale (CDS\/M&amp;V scale);<\/li>\r\n\r\n\r\n\r\n<li>Digestive Disease Week-Japan (DDW-J);<\/li>\r\n\r\n\r\n\r\n<li>DILIN Expert Opinion.<\/li>\r\n<\/ul>\r\n\r\n\r\n\r\n<p class=\"has-background\" style=\"background-color: #d8e0e2;\">Deve-se ter em mente, entretanto, que os escores n\u00e3o substituem os julgamento cl\u00ednico, sendo, na realidade, uma tradu\u00e7\u00e3o, em pontua\u00e7\u00e3o quantitativa, da suspeita cl\u00ednica de <em>DILI<\/em>.<\/p>\r\n\r\n\r\n\r\n<h2 class=\"wp-block-heading\"><strong>Avalia\u00e7\u00e3o Laboratorial para Exclus\u00e3o de Causas Alternativas<\/strong><\/h2>\r\n\r\n\r\n\r\n<p>O diagn\u00f3stico de <em>DILI<\/em> baseia-se na <strong>exclus\u00e3o<\/strong> de causas alternativas de agress\u00e3o hep\u00e1tica. O padr\u00e3o de les\u00e3o hep\u00e1tica pode auxiliar na investiga\u00e7\u00e3o inicial para descartar as principais causas de hepatite e colestase (Figura 1).\u00a0<\/p>\r\n\r\n\r\n\r\n<p>Em adi\u00e7\u00e3o, idade e comorbidades, h\u00e1bitos individuais dos pacientes e caracter\u00edsticas regionais de doen\u00e7as infecciosas que podem afetar o f\u00edgado podem guiar na avalia\u00e7\u00e3o (Tabela 2).<\/p>\r\n\r\n\r\n\r\n<p>A exclus\u00e3o de doen\u00e7a de Wilson com dosagem de ceruloplasmina deve ser realizada, em especial, em pacientes com menos de 40 anos.<\/p>\r\n\r\n\r\n<div class=\"wp-block-image\">\r\n<figure class=\"aligncenter size-full is-resized\"><a href=\"https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2023\/03\/post-dra-Karla.png\" data-rel=\"penci-gallery-image-content\" ><img decoding=\"async\" class=\"wp-image-5100\" src=\"https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2023\/03\/post-dra-Karla.png\" alt=\"\" width=\"597\" height=\"761\" srcset=\"https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2023\/03\/post-dra-Karla.png 711w, https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2023\/03\/post-dra-Karla-235x300.png 235w, https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2023\/03\/post-dra-Karla-585x745.png 585w\" sizes=\"(max-width: 597px) 100vw, 597px\" \/><\/a><\/figure>\r\n<\/div>\r\n\r\n<div class=\"wp-block-image\">\r\n<figure class=\"aligncenter size-full is-resized\"><a href=\"https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2023\/03\/image-3.png\" data-rel=\"penci-gallery-image-content\" ><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-5094\" src=\"https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2023\/03\/image-3.png\" alt=\"\" width=\"603\" height=\"436\" srcset=\"https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2023\/03\/image-3.png 573w, https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2023\/03\/image-3-300x217.png 300w\" sizes=\"(max-width: 603px) 100vw, 603px\" \/><\/a>\r\n<figcaption class=\"wp-element-caption\"><strong>Tabela 2. Diagn\u00f3stico de exclus\u00e3o na investiga\u00e7\u00e3o de <em>DILI<\/em><\/strong><\/figcaption>\r\n<\/figure>\r\n<\/div>\r\n\r\n\r\n<h2 class=\"wp-block-heading\"><strong>Recomenda\u00e7\u00e3o<\/strong><\/h2>\r\n\r\n\r\n\r\n<p class=\"has-background\" style=\"background-color: #d8e0e2;\">A ultrassonografia de abdome deve ser realizada em todos os pacientes com suspeita de DILI. Exame de imagem adicional poder\u00e1 ser indicado de acordo com o contexto cl\u00ednico-laboratorial. Grau B (EASL, 2019).<\/p>\r\n\r\n\r\n\r\n<h2 class=\"wp-block-heading\"><strong>Recomenda\u00e7\u00e3o<\/strong><\/h2>\r\n\r\n\r\n\r\n<p class=\"has-background\" style=\"background-color: #d8e0e2;\">A bi\u00f3psia hep\u00e1tica pode ser considerada em pacientes selecionados suspeitos para DILI, de forma que a histologia hep\u00e1tica possa fornecer informa\u00e7\u00f5es que embasem o diagn\u00f3stico de DILI ou uma alternativa (Grau D) ou quando os exames levantarem a possibilidade de HAI (Grau C); EASL, 2019.<\/p>\r\n\r\n\r\n\r\n<h2 class=\"wp-block-heading\"><strong>Conclus\u00e3o<\/strong><\/h2>\r\n\r\n\r\n\r\n<p>Em resumo, o principal passo no manejo dos casos de <em>DILI<\/em> \u00e9 a suspens\u00e3o de todas as drogas n\u00e3o-essenciais, incluindo formula\u00e7\u00f5es, suplementos, ervas e ch\u00e1s. Desta forma, a maioria dos pacientes cursar\u00e1 com recupera\u00e7\u00e3o espont\u00e2nea cl\u00ednica e\/ou laboratorial, sem a necessidade de medidas adicionais.<\/p>\r\n\r\n\r\n\r\n<p>Pacientes com evid\u00eancia cl\u00ednica ou laboratorial de IHF, como encefalopatia hep\u00e1tica ou coagulopatia, devem ser hospitalizados.\u00a0<\/p>\r\n\r\n\r\n\r\n<p>No geral, terapia medicamentosa fica reservada para situa\u00e7\u00f5es espec\u00edficas, como n-acetilciste\u00edna na intoxica\u00e7\u00e3o por paracetamol ou <em>DILI<\/em> idiossincr\u00e1sica com IHF ou cortic\u00f3ides, se houver a possibilidade de hepatite autoimune ou na presen\u00e7a de componentes de hipersensibilidade.<\/p>\r\n\r\n\r\n\r\n<p>A reexposi\u00e7\u00e3o \u00e0 droga <em>(\u201crechallenge\u201d)<\/em> \u00e9 a dado mais definitivo para o diagn\u00f3stico de <em>DILI<\/em> (ALT&gt;3xLSN), mas deve ser avaliada caso a caso, conforme a gravidade do epis\u00f3dio de <em>DILI<\/em> e necessidade da terapia medicamentosa (exemplo: agentes quimioter\u00e1picos ou tuberculost\u00e1ticos), sob supervis\u00e3o especializada e rigorosa.<\/p>\r\n\r\n\r\n\r\n<h2 class=\"wp-block-heading\"><strong>Refer\u00eancias<\/strong><\/h2>\r\n\r\n\r\n\r\n<ol class=\"wp-block-list\">\r\n<li>European Association for the Study of the Liver. Electronic address: easloffice@easloffice.eu, Clinical Practice Guideline Panel: Chair:, Panel members, <em>et al<\/em>. EASL clinical practice guidelines: drug-induced liver injury. <em>J Hepatol <\/em>2019;70:1222\u2013 61.<\/li>\r\n\r\n\r\n\r\n<li>Brennan PN, Cartlidge P, Manship T, Dillon JF. Guideline review: EASL clinical practice guidelines: drug-induced liver injury (DILI). Frontline Gastroenterol. 2021 Jul 29;13(4):332-336. doi: 10.1136\/flgastro-2021-101886. PMID: 35722609; PMCID: PMC9186030.\u00a0<\/li>\r\n\r\n\r\n\r\n<li>Chalasani NP, Maddur H, Russo MW, Wong RJ, Reddy KR; Practice Parameters Committee of the American College of Gastroenterology. ACG Clinical Guideline: Diagnosis and Management of Idiosyncratic Drug-Induced Liver Injury. Am J Gastroenterol. 2021 May 1;116(5):878-898. doi: 10.14309\/ajg.0000000000001259. PMID: 33929376.<\/li>\r\n\r\n\r\n\r\n<li>Garc\u00eda-Cort\u00e9s M, Stephens C, Lucena MI, Fern\u00e1ndez-Casta\u00f1er A, Andrade RJ. Causality assessment methods in drug induced liver injury: strengths and weaknesses. J Hepatol. 2011 Sep;55(3):683-691. doi: 10.1016\/j.jhep.2011.02.007. Epub 2011 Feb 22. PMID: 21349301.<\/li>\r\n\r\n\r\n\r\n<li>Bessone F, Garc\u00eda-Cort\u00e9s M, Medina-Caliz I, Hernandez N, Parana R, Mendizabal M, Schinoni MI, Ridruejo E, Nunes V, Peralta M, Santos G, Anders M, Chiodi D, Tagle M, Montes P, Carrera E, Arrese M, Lizarzabal MI, Alvarez-Alvarez I, Caballano-Infantes E, Niu H, Pinazo J, Cabello MR, Lucena MI, Andrade RJ. Herbal and Dietary Supplements-Induced Liver Injury in Latin America: Experience From the LATINDILI Network. Clin Gastroenterol Hepatol. 2022 Mar;20(3):e548-e563. doi: 10.1016\/j.cgh.2021.01.011. Epub 2021 Jan 9. PMID: 33434654.<\/li>\r\n<\/ol>\r\n\r\n\r\n\r\n<h2 class=\"wp-block-heading\"><strong>Como citar este artigo<\/strong><\/h2>\r\n\r\n\r\n\r\n<p class=\"has-background\" style=\"background-color: #d8e0e2;\">Oti, KST. Investiga\u00e7\u00e3o de<em> Drug-Induced Liver Injury (DILI):<\/em> principais conceitos e linha de racioc\u00ednio. Gastropedia 2023, vol. 1. Dispon\u00edvel em: https:\/\/gastropedia.pub\/pt\/gastroenterologia\/figado\/investigacao-de-hepatite-medicamentosa<\/p>\r\n","protected":false},"excerpt":{"rendered":"<p>Aspectos Gerais A hepatite medicamentosa (Drug-induced liver injury, DILI) \u00e9 um dos quadros mais desafiadores na Hepatologia devido a ampla disponibilidade de medica\u00e7\u00f5es, suplementos e ervas com potencial de hepatoxicidade&hellip;<\/p>\n","protected":false},"author":5590,"featured_media":5096,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_lmt_disableupdate":"","_lmt_disable":"","footnotes":""},"categories":[21,18],"tags":[],"ano":[137],"tipo":[121],"volume":[57],"class_list":["post-5089","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-figado","category-gastroenterologia","ano-137","tipo-assuntos-gerais","volume-volume-i"],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v27.2 (Yoast SEO v27.3) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>Investiga\u00e7\u00e3o de Hepatite Medicamentosa (Drug-Induced Liver Injury - DILI): principais conceitos e linha de racioc\u00ednio - Gastropedia<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/gastropedia.pub\/pt\/gastroenterologia\/figado\/investigacao-de-hepatite-medicamentosa\/\" \/>\n<meta property=\"og:locale\" content=\"pt_BR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Investiga\u00e7\u00e3o de Hepatite Medicamentosa (Drug-Induced Liver Injury - DILI): principais conceitos e linha de racioc\u00ednio\" \/>\n<meta property=\"og:description\" content=\"Aspectos Gerais A hepatite medicamentosa (Drug-induced liver injury, DILI) \u00e9 um dos quadros mais desafiadores na Hepatologia devido a ampla disponibilidade de medica\u00e7\u00f5es, suplementos e ervas com potencial de hepatoxicidade&hellip;\" \/>\n<meta property=\"og:url\" content=\"https:\/\/gastropedia.pub\/pt\/gastroenterologia\/figado\/investigacao-de-hepatite-medicamentosa\/\" \/>\n<meta property=\"og:site_name\" content=\"Gastropedia\" \/>\n<meta property=\"article:published_time\" content=\"2023-03-30T09:30:00+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2023-03-31T14:52:23+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/gastropedia.pub\/pt\/wp-content\/uploads\/2023\/03\/WhatsApp-Image-2023-02-27-at-18.41.19.jpeg?v=1677703911\" \/>\n\t<meta property=\"og:image:width\" content=\"1200\" \/>\n\t<meta property=\"og:image:height\" content=\"800\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/jpeg\" \/>\n<meta name=\"author\" content=\"Karla Sawada Toda Oti\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Escrito por\" \/>\n\t<meta name=\"twitter:data1\" content=\"Karla Sawada Toda Oti\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. tempo de leitura\" \/>\n\t<meta name=\"twitter:data2\" content=\"8 minutos\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/gastropedia.pub\\\/pt\\\/gastroenterologia\\\/figado\\\/investigacao-de-hepatite-medicamentosa\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/gastropedia.pub\\\/pt\\\/gastroenterologia\\\/figado\\\/investigacao-de-hepatite-medicamentosa\\\/\"},\"author\":{\"name\":\"Karla Sawada Toda Oti\",\"@id\":\"https:\\\/\\\/gastropedia.pub\\\/pt\\\/#\\\/schema\\\/person\\\/3f2ad5627016e96333ebd4302cd5a9a4\"},\"headline\":\"Investiga\u00e7\u00e3o de Hepatite Medicamentosa (Drug-Induced Liver Injury &#8211; 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