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Block 32- GI/surgery > Acute liver disease > Flashcards

Acute liver disease Flashcards

1
Q

phase 1 of drug metabolism =

A

oxidation, reduction, hydrolysis to add functional groups making drug more polar

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2
Q

what coordinates phase 1 of drug metabolism

A

CYP450 enzymes

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3
Q

where is phase 1 metabolism performed

A

endoplasmic reticulum

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4
Q

what is phase 2 of liver metabolism

A

conjugation making products water soluble

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5
Q

how are water soluble products excreted

A

urine

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6
Q

phase 3 =

A

excretion

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7
Q

how are highly polar molecules with a weight greater than 200kDa excreted

A

biliary excretion

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8
Q

3 antibiotics that can cause acute hepatic failure

A

ciprofloxacin
erythromycin
isoniazid

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9
Q

acute alcohol effect on CYP450 enzymes

A

inhibitory effect -drugs metabolised quicker

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10
Q

chronic alcohol effect on drug metabolism

A

induce synergy where the effect of the drug is enhanced

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11
Q

2 types of adverse drug reactions

A

type A -intrinsic

Type B -idiosyncratic

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12
Q

most common adverse drug reaction=

A

type A intrinsic

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13
Q

what happens in a type A reaction

A

predictable dose-response curve -higher dose causes more damage

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14
Q

characteristics of type A reaction

A
  • rarely dangerous
  • occurs after 1 dose
  • well characterised mechanism of toxicity
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15
Q

type B drug reactions =

A

non-predictable hepatotoxicity

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16
Q

characteristics of type B drug reaction

A
  • occurs without warning
  • not related to dose
  • hepatocellular injury not caused by drug itself but metabolites
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17
Q

what type of drug reaction is paracetamol

A

type A

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18
Q

what happens to paracetamol normally

A

conjugation with glucuronic acid and excreted via kidneys

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19
Q

in large doses when the conjugation pathway is saturated what happens to paracetamol

A

CYP450 metabolisation forming NAPQI

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20
Q

% of alcoholic hepatitis progressing to cirrhosis

A

80%

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21
Q

when does withdrawal start after last drink

A

10-72 hours after

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22
Q

signs of alcohol withdrawal (5)

A 
increased pulse 
decreased Bp 
tremor confusion 
fits 
hallucinations
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23
Q

what happens to alcohol in the liver

A

converted into acetaldehyde via alcohol dehydrogenase

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24
Q

what intermediate is needed for alcohol conversion

A

NADH

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25
Q

what does the conversion of NAD into NADH cause

A

fatty acid production

steatosis

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26
Q

what does the activity of alcohol dehydrogenase produce

A

reactive oxygen radicals

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27
Q

histological changes in alcohol hepatitis

A

mallory bodies

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28
Q

mallory bodies=

A

damaged intermediate filaments within cytoplasm of hepatocytes aggregated together (highly eosinophilic- pink)

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29
Q

AST raised in

A

acute liver damage

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30
Q

AST found in

A

liver parenchymal cells
heart
brain
muscle

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31
Q

ALT>AST=

A

viral hepatitis

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32
Q

AST>ALT=

A

chronic liver disease and cirrhosis

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33
Q

ALP found in

A

biliary ducts
bone
intestine
placenta

34
Q

GGT + ALP=

A

biliary disease

35
Q

GGT raised ALP normal=

A

alcohol abuse

36
Q

lifespan of erythrocytes

A

2-3 months

37
Q

solubility of unconjugated bilirubin

A

fat soluble

38
Q

what is bilirubin conjugated to (and via what enzyme)

A

glucuronic acid via glucuronyltransferase

39
Q

what happens after bilirubin is conjugated

A

becomes water soluble

40
Q

what happens to conjugated bilirubin in large intestine

A

turned into urobilinogen by commensal flora

41
Q

stercobilin colours the stool

A

brown

42
Q

urobilin colours urine

A

yellow

43
Q

conjugated bilirubin raised in which jaundice

A

hepatic

post hepatic

44
Q

unconjugated raised in

A

pre-hepatic

hepatic

45
Q

urobilinogen raised or normal in

A

pre-hepatic

46
Q

urobilinogen decreased in

A

hepatic

post-hepatic

47
Q

urine colour of pre-hepatic

A

normal

48
Q

urine colour in hepatic and post-hepatic

A

dark -conjugated bilirubin

49
Q

stool colour in pre-hepatic

A

normal

50
Q

stool colour in post and intra hepatic

A

pale

51
Q

which jaundice raises ALP

A

hepatic

post hepatic

52
Q

which jaundice raises AST, ALT

A

hepatic

post hepatic

53
Q

which jaundice causes splenomegaly

A

pre-hepatic

hepatic

54
Q

causes of pre-hepatic jaundice

A
  • hemolysis
  • physiological jaundice of the newborn
  • gilbert syndrome
  • crigler najjar syndrome
  • drugs
55
Q

gilbert syndrome=

A

mildly low UGT activity- jaundice when stressed

56
Q

Crigler-nijjar syndrome

A

absence of UGT -usually fatal

57
Q

what can physiological jaundice of the newborn cause

A

neurological deficits and death- UCB deposits in basal ganglia

58
Q

cause of physiological jaundice of newborn

A

low UGT activity

59
Q

treatment of physiological jaundice of newborn

A

phototherapy -making UCB water soluble

60
Q

why no bilirubinuria in pre-hepatic jaundice

A

UCB isn’t soluble

61
Q

bloods of hepatic jaundice

A

increased CB and UCB

62
Q

what happens to urine urobiliogen in hepatic jaundice

A

increases at first but normalises with time

63
Q

acute cholecystitis=

A

inflammation of gallbladder secondary to obstruction in cystic duct

64
Q

cholecystitis presentation

A
  • epigastric pain localising in RUQ
  • muscle guarding
  • murphy sign
  • rebound tenderness
65
Q

ascending cholangitis presentation (4)

A

fever
RUQ pain
jaundice
septic shock

66
Q

charcot’s triad for ascending cholangitis=

A

jaundice
RUQ pain
fever

67
Q

choledocholithiasis=

A

obstruction of common bile duct by gallstones

68
Q

what is ascending cholangitis secondary to

A

choledocholithiasis

69
Q

PSC presentation

A

fatigue
pruritus
jaundice
fever and rigors

70
Q

PBC presentation

A

jaundice
xanthomas
prurits
joint pain and arthropathy

71
Q

PSC frequently associated with

A

IBD

72
Q

PBC characterised by

A

anti-microbial antibodies

73
Q

benign bile duct strictures are a common complication of

A

biliary surgery- ERCP

74
Q

cholangiocarcinoma presentation

A

abdominal pain
ascites
malaise
jaundice

75
Q

acute liver failure=

A

rapid development of hepatocellular dysfunction - coagulopathy and encephalopathy without prior liver disease

76
Q

symptoms of acute liver disease (6)

A 
jaundice 
hepatic encephalopathy -confusion
asterixis/ CO2 flap 
N&V 
spider angiomas
77
Q

what zone does paracetamol overdose toxification occur in

A

zone 3 -as high levels of CYP450

78
Q

why might acute liver failure cause organ failure

A

systemic inflammatory syndrome

79
Q

treatment for paracetamol overdose

A

acetylcysteine

80
Q

treatment for autoimmune hepatitis (3)

A

benzylpenicillin
acetylcysteine
methylprednisolone

81
Q

opioid overdose give

A

naloxone

82
Q

triggers of decompensation for acute on chronic liver failure (4)

A

bacterial infection
alcohol
acute viral hepatitis
drug-induced liver injury

Block 32- GI/surgery (9 decks)

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