Liver 3

Question 1

What is 1 of the most common causes of elevated LFTs?

Answer 1

Drug induced liver injury/ toxic hepatitis

Question 2

What is the MCC of acute liver failure from drug induced liver injury?

Answer 2

Acetaminophen overdose

Question 3

What 2 abx are common causative agents of drug induced liver injury/ toxic hepatitis

Answer 3

Augmentin

Sulfonamides

Question 4

Presentation of what?

• Ranges from subclinical LFT elevation to acute liver failure

Answer 4

Drug induced liver injury/ toxic hepatitis

Question 5

In Drug induced liver injury/ toxic hepatitis, liver injury may develop how long after substance injestion

Answer 5

w/in days or several weeks

Question 6

How do you dx Drug induced liver injury/ toxic hepatitis

Answer 6

h/o injesting causative drug/toxin

Exclude other causes of liver disease

Question 7

How do you tx Drug induced liver injury/ toxic hepatitis?

Answer 7

• Remove causative agent and monitor for resolution of liver injury
• In severe cases of acute liver failure- liver transplant

Question 8

What is the toxic dose of Acetaminophen

Answer 8

10-20g

lower in alcoholics or patiens w/ liver dz

Question 9

Presentation of what?

• 30min- 24 hrs after ingestion- GI sxs
• 2d after ingestion- R sided abd pain, oliguria, elevated LFTs and prolonged PT/INR
• 3-5d after ingestion- Hepatic necrosis w/ elevated aminotransferases, +/- ALF
• 5-10d after- recovery phase (IF pt is going to recover)

Answer 9

Drug induced liver injury caused by Acetaminophen

Question 10

Drug induced liver injury caused by Acetaminophen:

How many days after ingestion do you see GI sxs?

Answer 10

30 min to 24 hrs

Question 11

If a patient is going to recover from acetaminophen induced Drug induced liver injury, how many days after ingestion will this occur

Answer 11

5-10days

Question 12

Drug induced liver injury caused by Acetaminophen

What 2 things indicate poor prognosis or need for liver transplant?

Answer 12

1. pH <7.3
2. Stage 3-4 encephalopathy w/ PT/INR >6.5 and Cr > 3.4

Question 13

How do you tx Drug induced liver injury caused by Acetaminophen

Answer 13

1. IV N-acetylcysteine
2. Charcoal if w/in 1hr of ingestion
3. Gastric lavage if w/in 4 hrs

Question 14

Alcoholic liver disease:

• Spectrum of what 3 abnormalities

Answer 14

1. Steatosis (fatty liver)
2. Steatohepatitis (alcoholic hepatitis)
3. Cirrhosis

Question 15

Clinical features of what?

• Range from asymptomatic to advanced liver failure
• Portal HTN
• +/-: fever, anorexia, RUQ pain, tender hepatomegaly, jaundice

Answer 15

Alcoholic liver dz

Question 16

Which condition has AST > ALT

Answer 16

Alcoholic liver disease

Question 17

Laboratory findings of what dz:

• Incr. Alk phos
• Incr. Triglycerides
• Decreased K, P, Mg
• Hyperglycemia
• AST>ALT

Answer 17

Alcoholic liver dz

Question 18

What are 3 components of diagnosis of alcoholic liver disease

Answer 18

1. h/o significant alcohol abuse
2. Exclusion of other forms of liver disease
3. Liver bx- determines severity

Question 19

How do you tx alcoholic liver dz?

Answer 19

Abstinence!!

(can stop progression of dz and may reverse damage)

Question 20

Alcoholic Liver disease

If Maddre’s discrimination function (DF) is > _____, patient has 50% mortality during current hospitalization

Answer 20

32