GI - Drug Induced Liver Failure, Acute Liver Failure And Alcoholic Ketoacidosis

Question 1

What categories can drug induced liver disease be generally divided into?

Answer 1

• Hepatocellular
• Cholestatic
• Mixed
• there is considerable overlap btw the two - some drugs cause range of changes in liver

Question 2

Name some drugs that tend to cause a Hepatocellular picture of liver disease

Answer 2

• Paracetamol
• Sodium valproate, phenytoin
• MAOIs
• halothane
• Anti-TB: isoniazid, rifampicin, pyrazinamide
• Statins
• Alcohol
• amiodarone
• methyldopa
• nitrofurantoin

Question 3

Name some drugs which tend to cause cholestatic (+/- hepatitis) pictures

Answer 3

• OCP
• ABX: flucloxacillin, co-amoxiclav, erythromycin
• anabolic steroids, testosterones
• phenothiazines: chlorpromazine, prochorperazine
• sulphonylureas
• vibrates

Question 4

Name drugs which tend to cause liver fibrosis:

Answer 4

• Methotrexate
• amiodarone
• methyldopa

Question 5

What derangement in parameters would you expect in a Hepatocellular disease type picture?

Answer 5

• ALT: raised at least 2 fold
• ALP: normal
• ALT/ALP: 5+

Question 6

What derangement in parameters would you expect in a cholestatic disease type picture?

Answer 6

• ALT: normal
• ALP: raised at least 2 fold
• ALT/ALP: <2

Question 7

W What derangement in parameters would you expect in a mixed disease type picture?

Answer 7

• ALT: raised at least 2 fold
• ALP: raised at least 2 fold
• ALT/ALP: 2-5

Question 8

What is alcoholic ketoacidosis?

Answer 8

• Non-diabetic euglycaemic form of ketoacidosis
• Occurs in pts who drink large amounts of alcohol - don’t eat regularly, may vomit food they do eat —> episodes of starvation and become malnourished
• Pt starts to break down body fat, producing ketones

Question 9

What pattern is normally seen in alcoholic ketoacidosis?

Answer 9

• Metabolic acidosis
• Elevated anion gap
• elevated serum ketone levels
• normal/low glucose concentration

Question 10

What is the Rx for alcoholic ketoacidosis?

Answer 10

-Infusion of saline and thiamine (required to avoid Wernicke encephalopathy or Korsakoff psychosis)

Question 11

What is acute liver failure?

Answer 11

-Rapid onset of Hepatocellular dysfunction (and possibly necrosis) leading to a variety of systemic complications

Question 12

Give 4 causes of acute liver failure

Answer 12

• Paracetamol overdose
• alcohol
• viral hepatitis (usual A or B)
• acute fatty liver of pregnancy

Question 13

Outline 5 features of liver failure

Answer 13

• Jaundice
• coagulopathy: raised PT time and low albumin (acurate measure of synthetic function of liver)
• Hepatic encephalopathy
• Renal failure: common - hepatomegaly syndrome