Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

GI/Hepatic Final > DILD > Flashcards

DILD Flashcards

1
Q

What are Hy’s laws?

A

ALT > 3x ULN and T Bili > 2x ULN
ALT > 3x ULN x symptoms
ALT > 5x ULN for > 2 weeks
ALT > 8x ULN anytime

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the symptoms for Hy’s law?

A 
Fatigue
N/V
RUQ pain or TN
Fever
Rash/eosinophilia (>5%)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What must be ruled out before determining fatal risk of DIL injury?

A

Viral and Environmental causes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are drug RFs for DILD?

A

Cumulative dose
Duration of treatment
Concurrent hepatotoxic agents (alcohol/APAP)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the disease RFs for DILD?

A

Chronic liver disease
Chronic renal disease
HIV
Obesity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the patient RFs for DILD?

A

Age (very young/old)

Occupation: agriculture, dyes (textile), plastic (fabrication)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What would we look for in a patient’s history as RFs for DILD?

A

Medical
Concurrent medication
Alcohol use

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the RFs for medications in DILD?

A

Dose (acute/cumulative)

Duration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Which phase in drug metabolism creates reactive metabolites?

A

Phase I

Potentially hepatotoxic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Which phase in drug metabolism creates inactive metabolies?

A

Phase II

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Lack of which metabolite causes hepatotoxic metabolites in APAP and bactrim?

A

Glutathione

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Which phase is glutathione a part of?

A

Phase II

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the three mechanisms of hepatic injury?

A

Intrinsic hepatotoxicity
Hypersensitivity
Idiosyncratic hepatotoxicity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is intrinsic hepatotoxicity?

A

Usually dose and/or duration dependent = time of onset (predictable)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are examples of intrinsic hepatotoxins?

A

Methotrexate (cumulative dose > 1.5g; duration > 2 yrs)

Ceftriaxone (dose > 1g/d; duration > 7 days)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How long is the sensitization period in hypersensitivity?

A

1-5 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are the systemic manifestations of hypersensitivity?

A

Eosinophilia
Rash
Fever

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What medications re common for hypersensitivity?

A

Amox
NSAIDs
Convulsants
Allopurinol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What causes idiosyncratic hepatotoxicity?

A

Toxic metabolites that result from abnormal metabolic pathways in a susceptible patient
Both genetic factor (enzyme deficiency) + acquired factor (age)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are drugs that cause idiosyncratic hepatotoxicity?

A

Valproic acid = results from enzyme deficiency (involving oxidation) greatest frequency in children < 2 yo
Isoniazid = slow acytelators (NAT2) = increase predisposition (increased in adults > 35 yo)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are the classifications of DILD?

A

Hepatocellular
Cholestatic
Vascular
Neoplasia (hepatic)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

How do hepatocellular changes cause DILD?

A

Interferes with metabolic processes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

How do cholestatic changes cause DILD?

A

Interferes with secretory processes

24
Q

What is a mixed presentation of DILD?

A

Has both hepatocellular and cholestatic causes for DILD

25
What is hepatocellular DILD?
Selective hepatocyte injury
26
What is the pathology hepatocellular DILD?
Local or diffuse necrosis | Steatosis = fat droplet deposition in the hepatocytes
27
What is the presentation of hepatocellular DILD?
Anicteric or icteric Resemble viral hepatitis = fever, arthralgias, hepatomegaly Labs = R >/= 5
28
How do we calculate R?
ALT/ULN ÷ AP/ULN
29
What can hepatocellular DILD lead to?
Fulminant hepatitis
30
What is fulminant hepatitis?
Encephalopathy Increased INR Death
31
What are the mortality rates for hepatocellular DILD?
>/= 10% if bili > 3x ULN
32
What is cholestatic DILD?
Selective disturbances in bile secretion
33
What is the pathology of cholestatic DILD?
Mild to severe canalicular cell damage | Disabled bile salt transport proteins
34
What is the presentation of cholestatic DILD?
``` Jaundice and pruritis Acholic stools (no bile = gray); dark urine (bilirubinuria) Severe form = fevere, RUQ pain Lab: R = 2; bile stasis with canalicular injury/inflammation ```
35
What drugs can cause cholestatic DILD?
Ceftriaxone
36
What is the mortality for cholestatic DILD?
< 1% - not fatal
37
What are the labs seen in mixed hepatocholestatic DILD?
R between 2 and 5
38
What drugs can cause mixed DILD?
Anticonvulsants Abx NSAIDs
39
How does vascular injury cause DILD?
Involves partial or full thrombosis of hepatic vein
40
What is Budd-Chiari syndrome?
``` Acute onset of ascites, rapid weight gain and jaundice + ab pain (severe upper quadrant) + Hepatomegaly Increased D-dimer LFTs variable but all elevated ```
41
What drugs can cause vascular injury?
BC (+ additional RFs)
42
What is hepatic neoplasia
Benign tumors filled with blood found w/in the liver that can rupture
43
What can hepatic neoplasia lead to?
Clinically dramatic hemoperitoneum upon rupture -May occur in as many as one third of cases -Rare, but seen with anabolic steroids (avg 6 yrs from initiation) Regression often occurs when the medication is withdrawn
44
What are the presentations of hepatic neoplasia?
Ab pain Wt loss Fatigue LFTs: mild increase
45
What are examples of drugs that cause hepatic neoplasia?
``` Anabolic steroids Oral contraceptives (HD estrogen) ```
46
What are the preventions for DILD?
Baseline LFTs Patient counseling (at the very least) Take precautionary measures
47
What sx do we tell a patient to contact their doctor if they develop?
N/V and/or ab pain of unexplainable origin lasting several days OR Mental status changes/bleeding episodes/jaundice
48
How often should LFT follow ups be preformed?
1-3 months
49
How do we take precautionary measures with intrinsic hepatotoxins?
Limit/watch dose | Duration of therapy
50
How do we take precautionary measures with hypersensivity reactions?
Watch for h/o allergies
51
How do we take precautionary measures with idiosyncratic hepatotoxins?
Watch for age/concurrent medications
52
How fast does a 50% reduction in LFTs occur upon discontinuation of hepatotoxin?
If injury is mild to moderate 2 weeks - hepatocellular 4 weeks - cholestatic
53
When do we not rechallenge?
Fulminant hepatitis | Hypersensitivity reaction
54
When do we rechallenge?
Diagnosis of DILD is questionable (only after s/sx resolved) AND Imperative medication only
55
How do we manage DILD?
``` Supportive care Symptomatic pruritis - cholestyramine Encephalopathy - lactulose Coagulopathy - vit K Spontaneous bacterial peritonitis - abx ```

GI/Hepatic Final (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions