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

Acute liver disease Flashcards

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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
what does the conversion of NAD into NADH cause
fatty acid production | steatosis
26
what does the activity of alcohol dehydrogenase produce
reactive oxygen radicals
27
histological changes in alcohol hepatitis
mallory bodies
28
mallory bodies=
damaged intermediate filaments within cytoplasm of hepatocytes aggregated together (highly eosinophilic- pink)
29
AST raised in
acute liver damage
30
AST found in
liver parenchymal cells heart brain muscle
31
ALT>AST=
viral hepatitis
32
AST>ALT=
chronic liver disease and cirrhosis
33
ALP found in
biliary ducts bone intestine placenta
34
GGT + ALP=
biliary disease
35
GGT raised ALP normal=
alcohol abuse
36
lifespan of erythrocytes
2-3 months
37
solubility of unconjugated bilirubin
fat soluble
38
what is bilirubin conjugated to (and via what enzyme)
glucuronic acid via glucuronyltransferase
39
what happens after bilirubin is conjugated
becomes water soluble
40
what happens to conjugated bilirubin in large intestine
turned into urobilinogen by commensal flora
41
stercobilin colours the stool
brown
42
urobilin colours urine
yellow
43
conjugated bilirubin raised in which jaundice
hepatic | post hepatic
44
unconjugated raised in
pre-hepatic | hepatic
45
urobilinogen raised or normal in
pre-hepatic
46
urobilinogen decreased in
hepatic | post-hepatic
47
urine colour of pre-hepatic
normal
48
urine colour in hepatic and post-hepatic
dark -conjugated bilirubin
49
stool colour in pre-hepatic
normal
50
stool colour in post and intra hepatic
pale
51
which jaundice raises ALP
hepatic | post hepatic
52
which jaundice raises AST, ALT
hepatic | post hepatic
53
which jaundice causes splenomegaly
pre-hepatic | hepatic
54
causes of pre-hepatic jaundice
- hemolysis - physiological jaundice of the newborn - gilbert syndrome - crigler najjar syndrome - drugs
55
gilbert syndrome=
mildly low UGT activity- jaundice when stressed
56
Crigler-nijjar syndrome
absence of UGT -usually fatal
57
what can physiological jaundice of the newborn cause
neurological deficits and death- UCB deposits in basal ganglia
58
cause of physiological jaundice of newborn
low UGT activity
59
treatment of physiological jaundice of newborn
phototherapy -making UCB water soluble
60
why no bilirubinuria in pre-hepatic jaundice
UCB isn't soluble
61
bloods of hepatic jaundice
increased CB and UCB
62
what happens to urine urobiliogen in hepatic jaundice
increases at first but normalises with time
63
acute cholecystitis=
inflammation of gallbladder secondary to obstruction in cystic duct
64
cholecystitis presentation
- epigastric pain localising in RUQ - muscle guarding - murphy sign - rebound tenderness
65
ascending cholangitis presentation (4)
fever RUQ pain jaundice septic shock
66
charcot's triad for ascending cholangitis=
jaundice RUQ pain fever
67
choledocholithiasis=
obstruction of common bile duct by gallstones
68
what is ascending cholangitis secondary to
choledocholithiasis
69
PSC presentation
fatigue pruritus jaundice fever and rigors
70
PBC presentation
jaundice xanthomas prurits joint pain and arthropathy
71
PSC frequently associated with
IBD
72
PBC characterised by
anti-microbial antibodies
73
benign bile duct strictures are a common complication of
biliary surgery- ERCP
74
cholangiocarcinoma presentation
abdominal pain ascites malaise jaundice
75
acute liver failure=
rapid development of hepatocellular dysfunction - coagulopathy and encephalopathy without prior liver disease
76
symptoms of acute liver disease (6)
``` jaundice hepatic encephalopathy -confusion asterixis/ CO2 flap N&V spider angiomas ```
77
what zone does paracetamol overdose toxification occur in
zone 3 -as high levels of CYP450
78
why might acute liver failure cause organ failure
systemic inflammatory syndrome
79
treatment for paracetamol overdose
acetylcysteine
80
treatment for autoimmune hepatitis (3)
benzylpenicillin acetylcysteine methylprednisolone
81
opioid overdose give
naloxone
82
triggers of decompensation for acute on chronic liver failure (4)
bacterial infection alcohol acute viral hepatitis drug-induced liver injury

Block 32- GI/surgery (9 decks)

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