Liver and Gallbladder

Question 1

In acute liver failure what can decline of serum transaminases suggest (after initial marked elevation)?

Answer 1

That there are few viable hepatocytes left or it could mean that they are improving, needs to be correlated with other signs and symptoms.

Question 2

Hepatic encephalopathy is believed to be caused by what?

Answer 2

Elevated ammonia levels (due to liver no longer being able to metabolise and so detoxify this)

Question 3

In chronic liver failure what is the cause of palmar erythema and spider angiomas of the skin? (And what other effects can it have in males)

Answer 3

Hyperestrogenemia from impaired estrogen metabolism. (hypogonadism and gynaecomastia)

Question 4

The diagnosis of autoimmune hepatitis (often insidious in presentation) is based on the combination of what four things?

Answer 4

• Autoantibodies
• Elevation of serum IgG
• Exclusion of other aetiologies (e.g. viral, drugs)
• Supportive histologic findings on liver biopsy

Question 5

What drugs are metabolised by the following cytochrome P450 subtypes respectively?
1. CYP - 1A2
2. CYP - 2E1
3. CYP - 2C9
4. CYP - 2D6
5. CYP - 3A4

Answer 5

1. Paracetamol
2. Ethanol
3. Warfarin
4. Most cardiovascular drugs
5. 60% of all drugs metabolised by P450 (including statin)

Question 6

Sort the following drugs into inducers or inhibitors of P450 enzymes:
- Alcohol
- Amiodarone
- Carbamazepine
- Chloramphenicol
- Grapefruit juice
- Griseofulvin
- Isoniazid
- Ketoconazole
- Macrolides except azythromycin
- Phenobarbital
- Phenytoin
- Quinidine
- Rifampin
- St John’s Wort
- Sulphonamides
- Sulphonylureas
- Valporate

Answer 6

Inducers:
- Alcohol
- Carbamazepine
- Griseofulvin
- Phenobarbital
- Phenytoin
- Rifampin
- St John’s Wort
- Sulphonylureas

Inhibitors:
- Amiodarone
- Chloramphenicol
- Grapefruit juice
- Isoniazid
- Ketoconazole
- Macrolides except azythromycin
- Quinidine
- Sulphonamides
- Valporate