Week 3 Liver - Forrester

Question 1

The Healthy Liver

Answer 1

• helps fight infections and cleans the blood.

* helps digest food and stores energy

Question 2

Inflammation

Answer 2

• swelling of the liver (hepatitis), is usually the first stage of liver disease
• If inflammation continues over time can cause scarring in the liver

Question 3

Fibrosis

Answer 3

• scarring of the liver
• If left untreated, the inflamed liver will start to scar
• Scar tissue can prevent blood from flowing through the
liver

Question 4

Cirrhosis

Answer 4

• Scarring of the liver – hard scar tissue replaces soft healthy tissue
• If cirrhosis is not treated, the liver will fail

Question 5

Liver Cancer

Answer 5

Cirrhosis and hepatitis B are leading risk factors

Question 6

liver failure

Answer 6

• Liver is losing or has lost all of its function (lifethreatening condition)
-means that the liver has been failing gradually
for some time

Question 7

acute liver failure especially after

Answer 7

acetominophen overdose

Question 8

Nonalcoholic fatty liver disease (NAFLD)

Answer 8

buildup of fat in the liver 
two types: 
o Nonalcoholic fatty liver (NAFL)
o Nonalcoholic steatohepatitis (NASH)
• To be diagnosed with either form of NAFLD, a person must not have a history of heavy alcohol use or another problem that might be causing the liver condition (ex. hepatitis C)
treatment: lifestyle management

Question 9

o Nonalcoholic fatty liver (NAFL)

Answer 9

, a benign condition in which there is fatty infiltration but no inflammation
➢ In NAFL, the liver functions normally and there are no symptoms.

Question 10

o Nonalcoholic steatohepatitis (NASH)

Answer 10

in which there is fatty infiltration along with liver inflammation
• although a similar condition can occur in people who abuse alcohol, NASH occurs in those who drink little to no alcohol
• The exact cause of NASH is unknown
➢ It occurs more frequently in people with certain medical conditions such as diabetes, obesity, and insulin resistance (this combination of disorders if often called the “metabolic syndrome”)

Question 11

First symptoms of liver failure are often:

Answer 11

• Nausea
• Loss of appetite
• Fatigue
• Diarrhea

Question 12

As liver failure progresses, symptoms may include:

Answer 12

• Confusion
• Extreme tiredness
• Coma

Question 13

Direct Hepatotoxicity

Answer 13

Serum enzyme elevations without jaundice
• Acute hepatic necrosis is the most common form
• Elevations resolve when the drug is stopped or the dose is lowered

Question 14

Idiosyncratic

Answer 14

• Caused by agents that have little or no intrinsic toxicity

* Cause liver injury only in rare cases

Question 15

Acute hepatocellular hepatitis (Idiosyncratic Hepatotoxicity)

Answer 15

• Most common manifestation
• Latency period generally ranges from 5 to 90 days
• Ex. isoniazid, nitrofurantoin, and diclofenac

Question 16

Cholestatic hepatitis (Idiosyncratic Hepatotoxicity)

Answer 16

• Characterized by pruritus and jaundice accompanied by moderateto-marked elevations in Alk phos levels
• Usually self-limited, and often protracted, but ultimately resolves
• Ex. amoxicillin–clavulanate, cephalosporins

Question 17

Mixed Hepatitis (Idiosyncratic Hepatotoxicity)

Answer 17

• Caused by many agents
• Tend to have benign outcomes, rarely leading to liver failure
• Ex. Fluoroquinolones, macrolide antibiotics,

Question 18

Bland cholestasis (Idiosyncratic Hepatotoxicity)

Answer 18

• Marked and prolonged jaundice with pruritus
• In women: typically caused by estrogens or oral contraceptives
• In men: typically caused by anabolic steroids

Question 19

ACETAMINOPHEN TOXICITY - DOSING AND

WARNINGS

Answer 19

▪ Adult: 650-1000 mg Q4-6 hrs
▪ Children: 10-15 mg/kg/dose Q4-6 hrs
▪ FDA max: 4000 mg/day
Acute toxicity:
≥ 7,500 mg single dose

Question 20

glutathione and NAPQI

Answer 20

glutathione binds to NAPQI to form a nontoxic metabolite, which is then renally excreted

Question 21

acute alcoholic intoxication or cirrhosis may increase

Answer 21

activity of cytochrome p450 and thus may be somewhat protected against acetominophen toxicity

Question 22

ACETAMINOPHEN TOXICITY - treatment

Answer 22

activated charcoal

▪ N-acetyl cysteine (NAC) (oral or IV)

Question 23

▪ N-acetyl cysteine (NAC) side effects

Answer 23

▪ IV- hypersensitivity reaction (10-20%); PO- vomiting (33%)

▪ Other: rash, itching