Acute and chronic liver diseases

Question 1

Causes of ALF

Answer 1

Acetaminophen toxicity (MC-USA)
viral hepatitis (MC-worldwide)
Wilson disease
Budd-Chiari syndrome
acute fatty liver of pregnancy, 
autoimmune hepatitis, 
Reye syndrome, and 
other idiosyncratic drug reactions (e.g., isoniazid, phenytoin, sulfonamides, propylthiouracil, azoles)

Question 2

Indicators of Poor Prognosis in Acute Liver Failure (King’s College Criteria)

Answer 2

Acetaminophen Toxicity
Arterial pH <7.3 after adequate fluid resuscitation

Or all of the following within a 24-hour period:
PT >100 sec (INR >6.5)
Serum Cr >3.4 mg/dL
Grade 3 to 4 HE

Non-Acetaminophen Causes of ALF
PT >100 sec (INR >6.5) and HE (irrespective of grade)
Or any three of the following:
Wilson disease, idiosyncratic drug reaction, seronegative, or indeterminate hepatitis
Jaundice >7 days before HE
Age <10 or >40 years
PT >50 sec (INR >3.5)
Bilirubin ≥17 mg/dL

Question 3

Drugs- Nonspecific or viral-like hepatitis

Answer 3

Aspirin, amiodarone, diclofenac, isoniazid, methyldopa, nitrofurantoin, phenytoin, propylthiouracil, sulfonamides

Question 4

Drugs-cholestasis

Answer 4

Carbamazepine, chlorpromazine, cotrimoxazole, haloperidol, tricyclics, estrogens, 17-α substituted steroids

Question 5

Drugs-Steatosis

Answer 5

Alcohol, prednisone, tetracycline, valproic acid, amiodarone, zidovudine

Question 6

Drugs- Granulomatous hepatitis

Answer 6

Allopurinol, quinidine, sulfonamides, sulfonylurea agents

Question 7

drugs-Adenomas and hepatocellular carcinoma

Answer 7

Estrogens and anabolic steroids

Question 8

Drugs-Veno-occlusive disease

Answer 8

Antineoplastics, azathioprine, pyrrolizidine alkaloids

Question 9

Medications for NAFLD

Answer 9

Amiodarone
Corticosteroids
Anabolic steroids
Tamoxifen
Perihexiline maleate
Tetracycline
Calcium channel blockers
Methotrexate