Several chemicals have been associated with occupational liver diseases, such as some solvents, pesticides, metals, etc. The latest European Association for the Study of the Liver (EASL) recommendations provide standardized nomenclature, definitions and classification of the type of liver injuries associated with occupational exposures.

Key recommendations:

• Workers with potential exposure to hepatotoxic chemicals should receive a document stating the chemicals used in the factory. The document may be made available to the workers without request.
• Caregivers and workers exposed to liver enzyme inducers and/or using enzyme inducing drugs to be informed about the possibility of interactions with anticonvulsant drugs.
• Attending physician must inform the caregivers and workers about the toxicity of alcohol to the liver and that it increases the likelihood of liver toxicities due to occupational exposure.
• Attending physician may advise occupational workers with classical risk factors of fatty liver to undergo a baseline screen for NAFLD/non-alcoholic steatohepatitis (NASH), alcohol-related fatty liver disease (AFLD)/alcohol-related steatohepatitis (ASH), and a close follow-up.
• Workers with cured hepatitis C or controlled chronic hepatitis B virus infection and clinical data suggestive of NAFLD/NASH, AFLD/ASH are suggested to undergo screening for the concurrent presence of NAFLD/NASH, AFLD/ASH and/or residual fibrosis to better define their risk profile on exposure to chemicals.
• Evaluate the severity of acute chemical liver injury using the adapted severity index scale designed for drug-induced liver injury (DILI).
• Diagnosis of occupational liver disease (OLD) to be based on the judgment of an expert occupational physician. The assessment of OLD may be improved by input from a multidisciplinary team including hepatologists, pathologists, toxicologists, and epidemiologists.
• Staging of OLD can involve evaluation with repeat measurements of liver tests and liver stiffness by transient elastography or serum predictors of fibrosis (Fib-4 and APRI) after the patient is removed from occupational exposure to suspected toxicants.
• Liver biopsy may be performed in those with persistently abnormal non-invasive liver tests, based on the clinical context and the extent of liver abnormalities.
• When performing a liver biopsy to diagnose a liver mass, it is suggested to sample the non-tumoral liver.

Source: EASL Clinical Practice Guideline: Occupational liver diseases. Available from: https://easl.eu/publication/occupational-liver-diseases/