Flashcards in Drug Induced Liver Failure Deck (25):
Any type of liver injury can be caused by medications that you will prescribe
Liver injury by oral contraceptives is idiosyncratic which means
Its unpredictable, not dose dependent
What type of cholestasis do we often see with oral contraceptives?
Estrogen does what to Na/K ATPase and Bile Salt Transport
What is Budd Chiari syndrome?
Hepatic vein thrombosis...can be caused by oral contraceptives
What is Peliosis?
Blood filled venous lakes
So oral contraceptives can cause what types of liver complications?
- Budd Chiari
- Peliosis Hepasis
- Focal Nodular Hyperplasia- vascular injury on the arterial side
Hepatic adenoma will present as
Some woman comes in, she's been taking oral contraceptives, she has abdominal pain and hypotension. This occurs because this adenoma grows with exposure to estrogen and has ruptured through the walls of the vasculature causing her to bleed
Always consider occupational chemical exposure
polyvinyl chloride exposure, think...
angiosarcoma of the liver, very rare
Increasing cause of acute liver failure...No cases were noted prior to 1980.
When you get too much acetaminophen what happens
Two of the normal breakdown pathways get saturated (Glucuronidation and Arylsulphotransferase) and the acetaminophen starts to go down the pathway of getting oxidized. This is bad news
Alcoholics have less of what enzyme. This is why alcoholics are often the most susceptible to liver injury by acetaminophen.
Glutathione. THis is the enzyme that binds to the oxidized product to prevent injury
Alcoholics also have a revved up p450
Acetaminophen is unsafe even in low doses in ppl with alcoholic liver disease
Acetaminophen is well tolerated in ppl with non-alcoholic liver disease
Even ppl with Cirrhosis from non-alcoholic causes are usually ok because they have low p450 and high glutathione levels
What is the antedote
Treatment= No alcohol, no acetaminophen, give N-acetylcystein
Carbon tetrachloride is kinda the opposite of an oral contraceptive regarding its hepatotoxicity....how
Carbon tetrachloride is an intrinsic hepatotoxin meaning that its mode of injury is predictable, dose dependent, can be reproduced in animals, etc...
Oral contraceptives are idiosyncratic hepatotoxins meaning that they follow no pattern. They are unpredictable, not dose dependent, cannot be reproduced in animals, etc...
Estrogen does what to membrane fluidity?
Oral contraceptives typically induce what types of complication
vascular....including Budd Chiari, Peliosis hepatis, focal nodular hyperplasia
Eosinophils look like what
Bi-lobed nucleus w/ pink-red cytoplasm