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Pharmacology > Liver (exam 3) > Flashcards

Liver (exam 3) Flashcards

1
Q

functions of liver in the body

A

production of bile
clearing of drugs/chemicals from blood
production of proteins for blood plasma
production of cholesterol
conversion of excess glucose to glycogen
regulation of blood levels of aa
processing hemoglobin

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2
Q

highest concentration of cells in liver

A

hepatocytes

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3
Q

HSC

A

hepatic stellate cells
major storage for vitamin A
serves as an APC

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4
Q

functions of HSC as an APC

A

mediate autophagy
controls apoptotic body engulfment
modulates activity of dendritic cells, macrophages and NK cells

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5
Q

HSC also produce/respond to various _____________________ that are linked to _________________ immune responses

A

interleukins, ICAM-1, IFN-g, and B7-H1

adaptive/innate

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6
Q

carcinogen that can cause liver injury that is in foods

A

nitrocinamines

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7
Q

most common stains used for liver

A

H&E
PAS

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8
Q

H&E

A

hematoxylin and eosin
identify injury

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9
Q

PAS

A

periodic acid-schiff reagent
identify injury and glycogen levels

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10
Q

idiosyncratic hepatotoxins

A

unpredictable reactions in a small number of individuals
irreproducible, variable latent period

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11
Q

are idiosyncratic hepatotoxins dose dependent?

A

NO!

it is dose-independent and diverse

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12
Q

drugs that can cause idiosyncratic hepatotoxins

A

allopurinol
chlorpromazine
INH
phenytoin
chlorpropamide
methyldopa
erythromycin derivative
statins
nitrofurantoin

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13
Q

intrinsic hepatotoxins

A

produce liver damage in a predictable manner
dose dependent

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14
Q

examples of intrinsic hepatotoxins

A

acetaminophen
ethanol
methotrexate
oral contraceptives
valproic acid
heavy metals
mycotoxins (amatoxins, aflatoxins)
CCl4, CHCl3 (halogenated hydrocarbons)

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15
Q

liver conditions tend to have

A

overlapping features

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16
Q

necrosis

A

direct damage to liver parenchyma
most common

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17
Q

liver levels in someone with necrosis

A

asymptomatic elevation of liver enzymes
elevated serum ALT/AST activities

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17
Q

spotty necrosis

A

resembles classic viral hepatitis and involves all acinar zones

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18
Q

what is common with massive liver injury?

A

massive inflammation

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19
Q

liver infarcts

A

yellow with geographic borders and surrounding hyperemia

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19
Q

acetaldehyde gets converted to ________________ by _________________

A

acetate

aldehyde dehydrogenase

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20
Q

why are liver infarcts uncommon?

A

because the liver has 2 blood supplies

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20
Q

ethanol gets converted to __________________ by _________________________

A

acetaldehyde

alcohol dehydrogenase

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20
Q

ethanol can go through an alternative metabolic pathway via

A

cytochrome P-450 oxygenase

(if 2E1)

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21
Q

antizol

A

fomepizole

competitive inhibitor of alcohol dehydrogenase

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21
Q

what is antizol used in?

A

methanol and ethylene glycol poisoning

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22
Q

antabuse

A

disulfiram

inhibits aldehyde dehydrogenase

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23
Q

what is Antabuse used in?

A

aid in management of chronic alcohol patients

causes disulfiram reaction

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24
Q

hangover

A

unpleasant physical and mental symptoms that occur after a bout of heavy alcohol drinking

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25
Q

overall symptoms of a hangover

A

fatigue
headache
muscle aches
n/v
you guys should know the rest lol

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26
Q

sensory symptoms of hangover

A

vertigo
sensitivity to light

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27
Q

cognitive symptoms of hangover

A

decreased attention and concentration

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28
Q

mood symptoms of a hangover

A

depression
anxiety
irritability

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29
Q

sympathetic hyperactivity of a hangover

A

tremor
sweating
increased pulse and systolic BP

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30
Q

what is the most important laboratory test to obtain from a seemingly intoxicated patient?

why?

A

rapid bedside serum glucose measurement

intoxication can cause hypoglycemia –> changes in mental status and seizures

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31
Q

the metabolism of ethanol impairs

A

gluconeogenesis (inc conversion of pyruvate to lactate)

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32
Q

who are susceptible to ethanol associated hypoglycemia even when ingesting small amounts?

A

children

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33
Q

mickey finn

A

date rape drugs/knock out drops
mixture of ethanol and chloral hydrate
have additive sedative effects

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34
Q

is there an interaction between ethanol and cocaine?

if so, what is formed? and what can it cause?

A

yes

cocaethylene is formed in the liver

can be cardiotoxic and lethal

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35
Q

what can explain why some ethnic groups have higher/lower rated of alcohol related problems?

A

genetic differences in liver enzymes

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36
Q

hepatitis

A

inflammation of liver tissue
release of chemotactic factors
activation of kupffer cells/macrophages
macrophages release endothelial cell GF
activated phagocytes release ROS and BRIs

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37
Q

hormonal contraception can cause

A

structural changes in the liver

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38
Q

INH- induced hepatitis can be

A

mild to fatal

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39
Q

amiodarone hepatitis can be

A

untreatable since the long half life
no effective way to stop exposure of the drug

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40
Q

statins can cause

A

elevation of LFTa

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41
Q

is there specific drugs that cause hepatitis?

A

NO!

any drug can be a cause of hepatitis

42
Q

atorvastatin induced acute hepatitis

A

mixed parenchymal inflammation
no bile duct damage or fibrosis

43
Q

cholestasis

A

diminution/cessation of bile flow

44
Q

cholestasis can result from

A

interference with bile secretion
inhibition of bilirubin uptake from blood
occlusion of the bile duct

45
Q

types of cholestasis

A

acute or chronic

46
Q

prolonged blockage of the bile duct can cause decrease ____________________ and an increase in ________________________ which is diagnostic for ___________________

A

elimination of conjugated bilirubin

conjugated bilirubin in the plasma

obstructive jaundice

47
Q

cholestasis patients show

A

elevated blood levels of bilirubin
normal/mildly elevated ALT and AST
elevated levels of alkaline phosphate

48
Q

any drug causing submissive hepatocellular injury may be followed by

A

fibrosis. nodular regeneration and cirrhosis

49
Q

in relation to hepatic fibrosis, some agents can produce an _____________________________ with no minimal features of _______________ or ________________

A

increase in collagen deposition

necrosis

inflammation

50
Q

hepatic fibrosis characteristics

A

increased number of kupffer cells, endothelial cells, TGF-b activation
release of fibroblast GF and ROS production

51
Q

hepatic fibrosis leads to differentiation and proliferation of _________________ transforming them into _________________

A

fat storing cells (HSC)

myofibroblasts

52
Q

myofibroblasts

A

produce large amounts of collagen
responsible for fibrosis of the liver

53
Q

drugs leading the hepatic fibrosis

A

methotrexate
hypervitaminosis-A
vinyl chloride
heroin

54
Q

biomarkers of liver cell injury

A

ALT
AST
GLDH
gamma GT
LDH5

55
Q

biomarkers of inflammation

A

CRP
alpha 2 M
haptoglobin
chemokines

56
Q

biomarkers of fibrogenesis

A

fibrogenic cytokines
CTGF
circulating fibrocytes
CSF
chemokines

57
Q

biomarkers of fibrosis and ECM turnover

A

hyaluronan
P3NP
MMPs
TIMPs
laminin

58
Q

myofibroblasts leads to an increase in

A

collagen
elastin
glycoproteins
proteoglycans
hyaluronan

59
Q

three types of fatty liver

A

steatosis
steatohepatitis
phospholipidosis

60
Q

steatosis

A

intracellular accumulation of fat
can be micro vesicular or macro vesicular

61
Q

intracellular fat accumulation is not directly

A

toxic but reflects abnormal metabolism

62
Q

an example of steatosis

A

NAFLD

63
Q

causes of a fatty liver

A

TPN
methotrexate
griseofulvin
tamoxifen
steroids
valproate
amiodarone
diseases

64
Q

fatty livers occurs primarily because of

A

disrupted liver metabolism

65
Q

in a fatty liver, lipid content is ___________ by weight and there is an ____________________

A

over 5%

accumulation of TG

66
Q

inhibition of _______________ results in steatosis

why?

A

protein synthesis

synthesis of lipoproteins is necessary for release of TG from hepatocytes

67
Q

is ALT and AST elevated in a fatty liver?

A

mild to moderate

68
Q

fatty liver can lead to

A

cirrhosis and liver failure

69
Q

amiodarone induced steatohepatitis

A

hepatocyte ballooning
numerous mallory hyaline
minimal steatosis

70
Q

amiodarone induced phospholipidosis

A

formation of lysosomal inclusion bodies due to accumulation of amiodarone
can be in liver and lung

71
Q

alpha-1antitrypsin deficiency

A

more likely to develop COPD with pan lobular emphysema

collections of alpha-1-antitrypsin are not being excreted from hepatocytes

72
Q

AAT deficiency can lead to

A

chronic hepatitis and cirrhosis (COPD as well)

73
Q

_________________ is more likely to occur in children with AAT deficiency, while ______________ occurs in adults

A

liver disease

lung disease

74
Q

cirrhosis is ______________ and has ____________ prognosis for survival

A

not reversible

poor

75
Q

cirrhosis usually results from

A

repeated exposures to chemical toxins

76
Q

chemical toxins that cause cirrhosis

A

ethanol
viral hepatitis
diabetic liver

77
Q

at early stages of cirrhosis there is increased

A

incorporation of proline into collagen

78
Q

In cirrhosis, what is impaired?

A

regeneration

79
Q

_________________ appear in network of collagen throughout large portions of the liver

A

single necrotic cells

80
Q

what causes fibrotic changes in cirrhosis

A

increased generation of hydroproline

81
Q

what type of prolonged therapy can lead to cirrhosis?

A

methotrexate
INH
ticynafen
perhexiline
enalapril
valproic acid

82
Q

macronodular cirrhosis

A

nodules are larger than 3 mm
caused by ongoing liver damage with liver cell necrosis followed by fibrosis and hepatocyte regeneration

83
Q

examples of macro nodular cirrhosis

A

viral hepatitis B or C (most common)
Wilson’s disease
alpha-1-antitrypsin deficiency

84
Q

iron accumulation may lead to

A

micro nodular cirrhosis

85
Q

hemosiderosis vs hemochromatosis

A

hemosiderosis - benign accumulation of iron

hemochromatosis - organ dysfunction occurs

86
Q

when there is an excess of iron in the liver, hepatocytes and kupffers cells get full of

A

granular brown deposits of hemosiderin

87
Q

in what conditions of hepcidin does iron accumulate in the cells?

A

high hepcidin conditions

88
Q

in the presence of hepcidin, iron is _____________ which eventually shed from the intestinal tract and ________________

A

retained in duodenal enterocytes

block iron absorption from the diet

89
Q

granulomatous hepatitis

A

granulomas are part of a broader inflammatory reaction involving the liver
evidence of hepatocellular dysfunction

90
Q

drugs implicated with granulomatous hepatitis

A

carbamazepine (common)
sulfonamide
sulfonylurea
phenytoin
quinidine
hydralazine

91
Q

allopurinol is known to cause

A

granulomas with a fibrin ring

92
Q

granuloma formation are regarded as a

A

host attempt to protect against poorly soluble exogenous/endogenous irritants

93
Q

autoimmune hepatitis

A

active necroinflammatory lesions with prominent plasma cells
leads to progressive damage of the liver

94
Q

autoimmune hepatitis symptoms

A

fatigue
anorexia
weight loss
jaundice
ascites
portal HTN
hepatomegaly
splenomegaly

95
Q

serology used to look for autoimmune hepatitis

A

anti smooth muscle antibody
anti nuclear antibody
lupus erythematous factor with elevated gamma globulin levels

96
Q

treatment for autoimmune hepatitis

A

prednisone and azathioprine (Imuran)

NO CURE

97
Q

most common form of autoimmune hepatitis

A

type I
found in association with other autoimmune disorders

98
Q

minocycline induced autoimmune hepatitis

A

necroinflammatory activity with numerous plasma cells

99
Q

venoocclusive disease

A

drugs than injure sinusoids, hepatic veins and hepatic arteries

100
Q

________________ can cause VD in patients with renal transplant, bone marrow transplant, and on long term treatment for IBD

A

azathioprine

101
Q

what can lead to VD with or without necrosis?

A

alcohol
excessive vitamin A
floxuridine

102
Q

budd chiari syndrome

A

thrombosis of the hepatic vein and inferior vena cava can lead to an enlarged liver, abdominal pain, ascites, and liver failure

103
Q

drug that causes Budd chiari syndrome

A

birth control pills

104
Q

how do oral contraceptives cause VD?

A

can cause focal sinusoidal dilations –> peliosis hepatis

105
Q

how do herbal tea preps cause VD?

A

alkaloids may cause acute ascites, rapid weight gain, abdominal pain, hepatomegealy
reversible

106
Q

chemically induced neoplasia

A

tumors derived from hepatocytes/bile duct cells
malignant angiosacrcomas from sinusoidal lining cells

107
Q

hepatocellular cancer

A

linked to abuse of androgens
high prevalence of aflatoxin-contaminated diets

108
Q

agents linked to malignant hepatic neoplasms

A

vinyl chlorine and thorium dioxide

109
Q

examples of liver carcinogens

A

dimethylnitrosamine
aflatoxin
arsenic
polycyclic aromatic hydrocarbons
DMBA
TCDD

Pharmacology (18 decks)

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