Drugs and Diseases: Liver

Question 1

symptoms of jaundice?

Answer 1

yellow skin/sclera from bilirubin

Question 2

what causes prehepatic jaundice?

Answer 2

hemolysis - sickle cell anemia, malaria

Question 3

what causes hepatic jaundice?

Answer 3

liver damage - cirrhosis, hepatitis

Question 4

what causes posthepatic jaundice?

Answer 4

bile duct obstruction - tumor, bile stones

Question 5

what causes newborn jaundice?

Answer 5

hepatic bilirubin glucuronyl transferase - can’t conjugate bilirubin to glucuronate

Question 6

what test is used to verify jaundice?

Answer 6

bilirubin level = total bilirubin + direct bilirubin

Question 7

what does direct bilirubin measure?

Answer 7

conjugated bilirubin level

Question 8

how can you tell b/w conjugated and unconjugated bilirubin? (where found or not found)

Answer 8

conjugated: in urine
unconjugated: not in urine

Question 9

what does high bilirubin in urine suggest?

Answer 9

conjugated hyperbilirubinemia

Question 10

what does absence of bilirubin in urine suggest?

Answer 10

unconjugated hyperbilirubinemia

Question 11

what is Gilbert syndrome?

Answer 11

glucuronyl transferase deficiency - asymptomatic

-increased unconjugated bilirubin (indirect)

Question 12

what is Dubin-Johnson syndrome?

Answer 12

impaired biliary secretion

-increased conjugated bilirubin (direct)

Question 13

what does high bilirubin indicate?

Answer 13

liver damage

Question 14

what does high serum AST, ALT indicate?

Answer 14

hepatocellular injury

Question 15

what does high alkaline phosphatase indicate?

Answer 15

cholestasis

Question 16

what does low albumin indicate?

Answer 16

chronic liver disease

Question 17

what does increased prothrombin time indicate?

Answer 17

low clotting factor production due to liver disease

Question 18

what are some manifestations of liver disease? (7 things)

Answer 18

• jaundice, scleral icterus
• spider angioma
• gynecomastia
• encephalopathy
• asterixis
• ascites
• abnormal blood coagulation

Question 19

what inhibits CYP3A4?

Answer 19

furanocoumarin (in grapefruit) - don’t take w/ statins

Question 20

what does tylenol + Etoh result in the production of?

Answer 20

NAPQI

Question 21

what are porphyrias?

Answer 21

defects in heme biosynthesis

Question 22

what is the most common porphyria?

Answer 22

porphyria cutanea tarda

Question 23

symptoms of porphyrias in general

Answer 23

• adult onset
• neurovisceral symptoms
• increased ALA or PBG
• accumulations in skin, liver, bone marrow

Question 24

how can you treat porphyrias?

Answer 24

hematin (exogenous heme -> decrease heme synthesis)

Question 25

erythropoeitic protoporphyria: deficient enzyme, accumulations, symptoms?

Answer 25

deficient ferrochetalase
accumulate protoporphyrin
photosensitivity

Question 26

porphyria cutanea tarda: deficient enzyme, accumulations, symptoms?

Answer 26

deficient URO decarboxylase
accumulate uroporphyrinogen III
photosensitivity

Question 27

what is used to measure Fe status?

Answer 27

ferritin

Question 28

what is zellweger syndrome?

Answer 28

peroxisome disease - no peroxisome fxn

Question 29

what is the function of fibrates?

Answer 29

bind PPARs, activate them -> increase TG oxidation -> decrease TG levels