Liver

Question 1

Liver

Answer 1

-metabolism: AA, carbs, lipids (bile)
-synthesis: proteins (albumin, clotting factors, angiotensinogen), cholesterol, TG, thrombopoietin
-Detoxification: food, drugs, herbals

Question 2

AST, ALT, ALP

Answer 2

used for acute liver injury, values start to normalize when patient becomes chronic

Question 3

albumin, PT/INR

Answer 3

synthetic function for chronic patients

Question 4

ALP

Answer 4

-used acutely but changes occur when there is damage to bile movement from liver to duodenum
-cholestatic

Question 5

Ratio

Answer 5

(ALT/ULN (40)) / (ALP/ULN (140))

Question 6

hepatocellular

Answer 6

> /= 5
more likely to be fatal do not rechallenge drug

Question 7

cholestatic

Answer 7

</=2
more likely to be prolonged and cause continuing liver injury, can consider rechallenge but should avoid

Question 8

mixed

Answer 8

2-5
best prognosis, if you have to rechallenge use for short duration

Question 9

NAC

Answer 9

-dose >7.5 mg (adults) or >/= 150 mg (children)
-more NAPQI produced then attack hepatocytes
-inc AST
-consider activated charcoal if 1-2 hrs post dose
-admin 8 hrs post overdose
-150 APAP conc at 4 hrs post overdose
-after 24 hrs regardless of APAP level admin NAC
-After 24 hrs or unknown ingestion time w/detectable APAP level begin NAC
-use IV in pts with liver failure
-PO pretreatment with antiemetics
-IV SE: anaphylactoid rxns (pts can restart with recurrence even in severe rxns)