Guideline 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). 1 Guidelines 1. Screening and diagnosis Indications for screening: 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). C Screening for fatty liver: Consider baseline screening for nonalcoholic fatty liver disease/NASH, alcoholic fatty liver disease/alcoholic steatohepatitis and close follow-up in occupational workers with classic risk factors for fatty liver. C Consider screening for nonalcoholic fatty liver disease/NASH, alcoholic fatty liver disease and alcoholic steatohepatitis and/or residual fibrosis in workers with a hepatitis C cure or controlled chronic HBV infection. Consider screening for clinical data suggesting nonalcoholic fatty liver https://web.pathway.md/diseases/recNozCA7mpB7f9F4 1/3 6/30/23, 1:22 AM Occupational liver disease Pathway disease/NASH, alcoholic fatty liver disease/alcoholic steatohepatitis to better define their risk profile when exposed to chemicals. C Diagnosis: diagnose occupational liver disease based on the judgment of an expert occupational physician. Consider further assessment of occupational liver disease on a case-by-case basis by consultation with a multidisciplinary team including hepatologists, pathologists, toxicologists, and epidemiologists. B 2. Classification and risk stratification Severity grading: Consider the adapted severity index scale designed for DILI for the evaluation of severity of acute chemical liver injury. C Consider dynamic evaluation, including repeated liver tests and liver stiffness measurements by transient elastography or serum predictors of fibrosis such as Fib-4 and APRI, for staging of occupational liver disease after the patient is removed from occupational exposure to suspected toxins. C 3. Diagnostic procedures Liver biopsy: Consider liver biopsy in patients with persistently abnormal noninvasive liver tests, depending on the clinical context and the extent of the liver abnormalities. C Consider sampling of the non-tumoral liver when performing a liver biopsy to diagnose a liver mass. C 4. Patient education Patient awareness: inform workers with potential exposure to hepatotoxic chemicals that they should receive a document listing the chemicals used in the factory. Inform that this document may be made available to the workers without request. B Show 2 more 5. Quality improvement Public health reporting: inform the relevant health authorities and/or compensation agencies about a documented or suspected case of occupational liver disease. B References https://web.pathway.md/diseases/recNozCA7mpB7f9F4 2/3 6/30/23, 1:22 AM Occupational liver disease Pathway 1. Massimo Colombo. EASL clinical practice guidelines for the management of occupational liver diseases. Liver Int. 2020 Feb;40 Suppl 1 136 141. Open https://web.pathway.md/diseases/recNozCA7mpB7f9F4 3/3