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P&T Block 3 Pulm & GI > L71 > Flashcards

L71 Flashcards

1
Q

Causes of acute liver failure

A
  1. Acetaminophen OD
  2. Other drugs:
  3. Mushrooms
  4. Viral
  5. Alcohol
  6. Genetic: Wilson’s
  7. Pregnancy: Fatty Liver + HELLP
  8. Ischemic
  9. Budd Chiari
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2
Q

How is acetaminophen metabolized in the liver?

A

NAPQI = tox int

Bound to glutathione (gained from diet)

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3
Q

Labs for acetaminophen OD

A

↑↑↑AST/ALT - 10s of thousands (should be

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4
Q

What is the liver injury caused by acetaminophen OD?

A

Tubular necrosis

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5
Q

What is the King’s College Criteria for dx acetaminophen acute liver failure

A
  1. arterial pH 6.5 + Cr > 3 + grade 3/4 encephalopathy (aggressive or coma)
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6
Q

Treat acetamin OD

A

UNDER 3 hrs = activated charcoal

Otherwise, N-acetyl-cysteine IV

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7
Q

What vegetable might give you acute liver failure?

A

Amanita phalloides mushrooms

↑↑↑ AST/ALT in 10s thousands

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8
Q

Treat acute LF due to mushrooms

A

Penicillin G + milk thistle

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9
Q

If you get acute LF from starting a new drug, is it dose dep? What kind of drugs do this?

A 
NO
Like an allergic rxn, dose indep
Anti-convulsants: phenytoin, valproic acid
Antibiotics: macrolides 
NSAIDs
Herbals!!!
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10
Q

What viruses cause acute LF?

A

Hep A, B, D, E
Could be C but unlikely
All: ↑AST/ALT

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11
Q

Hep A transmission

A

Fecal-oral

Shellfish/polluted water

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12
Q

Dx Hep A infection? Can this go chronic?

A

Hep A IgM = infection
IgG = exposure
Can NOT go chronic - acute only

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13
Q

Hep B transmission

A

Sex, IVDU

Vertical trans in 3 world

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14
Q

Dx Hep B infection. Can this go chronic?

A

HBsAg
HBcAb IgM
Many adults get infection and clear -> immune
CAN go chronic, esp kids infected vertically

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15
Q

Why is Hep D infection unique? Dx.

A

Required Hep B!! Duh… you know this.

HDAb IgM

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16
Q

Hep E transmission - who are you most worried about getting this?

A

Fecal-oral

Acute LF severe in pregnant women

17
Q

What do labs look like for acute LF due to alcohol?

A

↑AST/ALT but not over 300
AST 2: ALT 1
Leukocytosis - aka you also might be thinking infection

18
Q

Treat alcohol acute hepatitis

A

Limited options: anti-inflams

GCs

19
Q

What genetic disease might cause acute LF in young pts accompanied by neurologic symptoms?

A

Wilson’s disease

Cu accumulation in liver + brain

20
Q

What labs are key signs for Wilson’s?

A

↓↓alk phos

Alk phos : total bili ratio

21
Q

What cause of acute LF would present with massive liver necrosis? What are the other lab findings you’d expect?

A 
Auto-immune hepatitis 
More likely to be reason for chronic hepatitis
Also:
↑AST/ALT
↑Alk phos
↑Bili
\+ IgG and auto-immune markers
22
Q

What 2 liver diseases are unique to pregnancy?

A

Hep E isn’t unique…

  1. Acute Fatty Liver Disease of Pregnancy
  2. HELLP = Hemolysis, Elevated Liver enzymes, Low Platelets
23
Q

Lab + histo findings of acute fatty liver disease of prenancy

A

AST/ALT 300-500
Microvesicular steatosis (US) = tiny fat in cells
More likely to be a dx of exclusion for acute LF in a pregnant woman

24
Q

What do you know about HELLP

A

Complication of pre-eclampsia

↑AST/ALT

25
Q

What is ischemic hepatitis? Causes

A 
↓perfusion to liver 
1. MI
2. Hypotension
3. Arrythmia
4. CHF
Etc etc
26
Q

Labs for ischemic hepatitis

A

↑↑↑ AST/ALT in thousands
↑LDH
Delayed ↑bili - slower to rise

27
Q

What is Budd Chiari Syndrome?

A

Hepatic vein thrombosis

28
Q

Triad of symptoms for Budd chiari

A

Abdominal pain
Hepatomegaly
New ascites

29
Q

Dx and treat acute LF due to Budd Chiari

A

Dx: radiology

Treat the underlying cause but might need TIPS or transplant

30
Q

Biopsy needed to dx HCC?

A

NOPE
H/o cirrhosis or Hep B alone
Radiology

31
Q

What score dets liver transplant priority

A

MELD score

P&T Block 3 Pulm & GI (31 decks)

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