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F3 E3 Shea > Liver 3 > Flashcards

Liver 3 Flashcards

1
Q

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

A

Drug induced liver injury/ toxic hepatitis

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2
Q

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

A

Acetaminophen overdose

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3
Q

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

A

Augmentin

Sulfonamides

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4
Q

Presentation of what?

  • Ranges from subclinical LFT elevation to acute liver failure
A

Drug induced liver injury/ toxic hepatitis

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5
Q

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

A

w/in days or several weeks

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6
Q

How do you dx Drug induced liver injury/ toxic hepatitis

A

h/o injesting causative drug/toxin

Exclude other causes of liver disease

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7
Q

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

A
  • Remove causative agent and monitor for resolution of liver injury
  • In severe cases of acute liver failure- liver transplant
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8
Q

What is the toxic dose of Acetaminophen

A

10-20g

lower in alcoholics or patiens w/ liver dz

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9
Q

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)
A

Drug induced liver injury caused by Acetaminophen

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10
Q

Drug induced liver injury caused by Acetaminophen:

How many days after ingestion do you see GI sxs?

A

30 min to 24 hrs

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11
Q

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

A

5-10days

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12
Q

Drug induced liver injury caused by Acetaminophen

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

A
  1. pH <7.3
  2. Stage 3-4 encephalopathy w/ PT/INR >6.5 and Cr > 3.4
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13
Q

How do you tx Drug induced liver injury caused by Acetaminophen

A
  1. IV N-acetylcysteine
  2. Charcoal if w/in 1hr of ingestion
  3. Gastric lavage if w/in 4 hrs
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14
Q

Alcoholic liver disease:

  • Spectrum of what 3 abnormalities
A
  1. Steatosis (fatty liver)
  2. Steatohepatitis (alcoholic hepatitis)
  3. Cirrhosis
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15
Q

Clinical features of what?

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

Alcoholic liver dz

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16
Q

Which condition has AST > ALT

A

Alcoholic liver disease

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17
Q

Laboratory findings of what dz:

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

Alcoholic liver dz

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18
Q

What are 3 components of diagnosis of alcoholic liver disease

A
  1. h/o significant alcohol abuse
  2. Exclusion of other forms of liver disease
  3. Liver bx- determines severity
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19
Q

How do you tx alcoholic liver dz? (6)

A
  • Abstinence!! (can stop progression of dz and may reverse damage)
  • Sufficient carbohydrates and colories
  • Nutritional support
  • Micronutrients- Folic acid and thiamine
  • Methylprednisolone
  • Pentoxifylline
20
Q

Alcoholic Liver disease

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

21
Q

Which tx for alcoholic liver disease reduces 4 week mortality and reduces the frequency of hepatorenal syndrome?

A

Pentoxifylline

22
Q

Which condition?

  • accumulation of triglyceride droplets in hepatocytes
  • Benign if no significant inflammation or fibrosis on bx
A

Hepatic steatosis

23
Q

Which condition?

  • Necroinflammatory changes on liver bx, may progress to cirrhosis
  • Pathogenesis: lipotoxic injury to hepatocytes
A

Non-alcoholic steatohepatitis

24
Q

What are the 5 risk factors of Nonalcoholic Fatty Liver Disease

A
  1. insulin resistance

2. Obesity

3. DM2

  1. Lipid abnormalities
  2. Meds- Tamoxifen and corticosteroids
25
Q

Presentation of what?

  • Usu. asymptomatic
  • +/- RUQ pain
  • Elevated aminotransferase
  • Hepatomegaly
A

Nonalcoholic fatty liver disease

Nonalcoholic steatohepatitis

26
Q

How do you dx NAFLD?

A

Liver bx- macrovesicular steatosis

(needed for dx as well as <4 EtOH drinks/day)

27
Q

How do you tx NAFLD?

A
  1. Weight loss
  2. Dietary fat restriction
  3. Exercise
28
Q

Which condition?

  • Usu. young women
  • Chronic hepatitis w/ high serum globulins
  • Characteristic liver histology
  • + ANA and/or smooth mm. antibody
  • Responds to corticosteroids
    *
A

Autoimmune hepatitis

29
Q

Who is autoimmune hepatitis MC in?

A

young to middle-aged women

30
Q

What condition:

  • Insidious onset
  • fatigue
  • jaundice
  • +/- hepatomegaly
  • Serum aminotransferase >1000
  • Increased total bili
  • Incr. alk phos
  • Incr. serum gamma globulin
A

Autoimmune hepatits

31
Q

What 4 Autoantibodies may be positive in autoimmune hepatitis?

(need at least 1 positive for a definitive dx)

A
  • ANA
  • Smooth muscle antibodies
  • Anti-SLA
  • Anti-LKM1
32
Q

What helps establish diagnosis of autoimmune hepatitis, evaluate severity and determine need for tx?

A

liver biopsy

33
Q

How do you tx autoimmune hepatitis?

A

Prednisone +/- azathioprine

(improves sxs)

34
Q

What is the tx goal in autoimmune hepatitis?

A

Remission:

  • no sxs
  • nl liver tests (AST/ALT <2 ULN)
  • nl liver tissue (no interface hepatitis)
35
Q

Autoimmune hepatitis:

If remission is achieved, how often should you follow up

A

Q 3-6 mo w/ hepatologist

(due to high likelihood of relapse)

36
Q

Which condition?

  • Autosomal recessive
  • impairment of cellular copper transport–> accumulation of copper in several organs (liver, brain, cornea)
  • Leads to cirrhosis
A

Wilson disease

37
Q

What condition do you see Kayser-Fleischer rings in?

A

Wilson Disease

38
Q

Classical clinical picture of what?

  • 5-35y/o
  • decreased serum ceruloplasmin
  • Kayser Fleischer rings
A

Wilson Disease

39
Q

What classic finding is found in the serum in Wilson disease

A

Decreased serum ceruloplasmin

40
Q

How do you tx Wilson disease?

A

D-penicillamine

+/- liver transplant

41
Q

Which condition?

  • Increased intestinal iron absorption–> iron deposited in mult. organs
  • Most asymptomatic
  • HFE gene mutation
A

Hereditary hemochromatosis

42
Q

How do you tx hereditary hemochromatosis?

A

Serial phlebotomy

43
Q

What 2 things can develop with long standing iron overload due to hereditary hemochromatosis?

A

cirrhosis

HCC

44
Q

WHich condition?

  • Infant w/ signs of liver disease (cholestasis, elevated LFTs)
  • S/s diminish by 18 y/o
A

Alpha-1 antitrypsin deficiency

45
Q

When should you suspect alpha-1 antitrypsin (AAT) deficiency

A

chronic hepatitis or cirrhosis of unknown cause

46
Q

How do you dx alpha-1 antitrypsin (AAT) deficiency

A

decreased serum AAT level

47
Q

How do you tx alpha-1 antitrypsin (AAT) deficiency

A

No specific therapy for associated liver dz

liver transplant for those with cirrhosis/liver failure

F3 E3 Shea (24 decks)

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