Drug Induced Liver Failure

Question 1

Remember

Answer 1

Any type of liver injury can be caused by medications that you will prescribe

Question 2

Liver injury by oral contraceptives is idiosyncratic which means

Answer 2

Its unpredictable, not dose dependent

Question 3

What type of cholestasis do we often see with oral contraceptives?

Answer 3

Bland cholestasis

Question 4

Estrogen does what to Na/K ATPase and Bile Salt Transport

Answer 4

Decreases them

Question 5

What is Budd Chiari syndrome?

Answer 5

Hepatic vein thrombosis…can be caused by oral contraceptives

Question 6

What is Peliosis?

Answer 6

Blood filled venous lakes

Question 7

So oral contraceptives can cause what types of liver complications?

Answer 7

• Vascular
• Budd Chiari
• Peliosis Hepasis
• Focal Nodular Hyperplasia- vascular injury on the arterial side

Question 8

Hepatic adenoma will present as

Answer 8

Some woman comes in, she’s been taking oral contraceptives, she has abdominal pain and hypotension. This occurs because this adenoma grows with exposure to estrogen and has ruptured through the walls of the vasculature causing her to bleed

Question 9

Hepatocellular carcinoma

Answer 9

rare

Question 10

Always consider occupational chemical exposure

Answer 10

ok

Question 11

polyvinyl chloride exposure, think…

Answer 11

angiosarcoma of the liver, very rare

Question 12

Acetaminophen (Tylenol)

Answer 12

Increasing cause of acute liver failure…No cases were noted prior to 1980.

Question 13

When you get too much acetaminophen what happens

Answer 13

Two of the normal breakdown pathways get saturated (Glucuronidation and Arylsulphotransferase) and the acetaminophen starts to go down the pathway of getting oxidized. This is bad news

Question 14

Alcoholics have less of what enzyme. This is why alcoholics are often the most susceptible to liver injury by acetaminophen.

Answer 14

Glutathione. THis is the enzyme that binds to the oxidized product to prevent injury

Question 15

Alcoholics also have a revved up p450

Answer 15

ok

Question 16

Acetaminophen is unsafe even in low doses in ppl with alcoholic liver disease

Answer 16

ok

Question 17

Acetaminophen is well tolerated in ppl with non-alcoholic liver disease

Answer 17

ok

Question 18

Even ppl with Cirrhosis from non-alcoholic causes are usually ok because they have low p450 and high glutathione levels

Answer 18

ok

Question 19

What is the antedote

Answer 19

N-acetylcysteine

Question 20

Treatment= No alcohol, no acetaminophen, give N-acetylcystein

Answer 20

ok

Question 21

Carbon tetrachloride is kinda the opposite of an oral contraceptive regarding its hepatotoxicity….how

Answer 21

Carbon tetrachloride is an intrinsic hepatotoxin meaning that its mode of injury is predictable, dose dependent, can be reproduced in animals, etc…

Oral contraceptives are idiosyncratic hepatotoxins meaning that they follow no pattern. They are unpredictable, not dose dependent, cannot be reproduced in animals, etc…

Question 22

Estrogen does what to membrane fluidity?

Answer 22

decreases it

Question 23

Oral contraceptives typically induce what types of complication

Answer 23

vascular….including Budd Chiari, Peliosis hepatis, focal nodular hyperplasia

Question 24

Eosinophils look like what

Answer 24

Bi-lobed nucleus w/ pink-red cytoplasm

Question 25

you will see tons of inflammatory cells in drug induced liver failure

Answer 25

Eosinophils, lymphocytes -small round nucles, neutrophils, etc…