Acute Liver Failure

Question 1

Toxic and Drug Induced Hepatitis =

Answer 1

DILI (Drug Induced Liver Injury)

Question 2

What are 2 common causes of DILI?

Answer 2

• Dose dependent (direct hepatotoxins)

- Idiosyncratic

Question 3

What is an example of a dose dependent direct hepatotoxin that causes DILI?

Answer 3

Acetaminophen

Question 4

With Dose dependent direct hepatotoxins that cause DILI, when will the onset be?

Answer 4

Within 48 hours

Question 5

DILI symptoms mimic?

Answer 5

Acute Cholecystitis

= RUQ pain, jaundice, N/V

Question 6

DILI symptoms?

Answer 6

RUQ pain, jaundice, N/V

- may see eosinophilia, fever, rash

Question 7

What is NOT (+) in DILI that IS (+) in Acute Cholecystitis?

Answer 7

Antimitochondrial antibodies (AMA)

Question 8

What is NOT (+) in DILI that IS (+) in Acute Cholecystitis?

Answer 8

Antimitochondrial antibodies (AMA)

Question 9

Treatment for DILI?

Answer 9

• Withdraw offending agent

Question 10

Complications of DILI?

Answer 10

Fulminant liver failure

Question 11

Healthy Acetaminophen level for healthy individuals?

Answer 11

3g/24 hours

Question 12

Healthy Acetaminophen level for liver disease patients?

Answer 12

2g/24 hours

Question 13

Symptoms of Acetaminophen overdose?

Answer 13

RUQ pain, N/V
Jaundice
ENCEPHALOPATHY (CNS issues)

Question 14

Symptoms of Acetaminophen overdose?

Answer 14

RUQ pain, N/V
Jaundice
ENCEPHALOPATHY (CNS issues)

Question 15

Treatment for Acetaminophen overdose?

Answer 15

N-Acetylcysteine

Liver transplant

Question 16

Complications of Acetaminophen overdose?

Answer 16

Liver failure and death

Question 17

Budd-Chiari Syndrome

Answer 17

Hepatic Vein Obstruction

Question 18

Occlusion of flow to the hepatic vein or IVC?

Answer 18

Budd-Chiari Syndrome

Question 19

When is Budd-Chiari Syndrome common?

Answer 19

Hypercoagulable states

- ex. Polycythemia vera

Question 20

Symptoms of Budd-Chiari Syndrome?

Answer 20

RUQ pain, jaundice

Ascites

Question 21

What tests should be done with Budd-Chiari Syndrome?

Answer 21

Contrast enhanced or pulsed doppler US

Question 22

What will the US show with Budd-Chiari Syndrome?

Answer 22

Occlusion

Question 23

What lobe is prominent in Budd-Chiari Syndrome?

Answer 23

Caudate lobe

Question 24

If a liver biopsy is done with Budd-Chiari Syndrome, what will it show?

Answer 24

Nutmeg liver

= Centrilobar congestion

Question 25

Nutmeg liver (centrilobar congestion) is seen with?

Answer 25

Budd-Chiari Syndrome liver biopsy

– occlusion of blood flow to hepatic vein