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Flashcards in Drug Induced Liver Failure Deck (25):
1

Remember

Any type of liver injury can be caused by medications that you will prescribe

2

Liver injury by oral contraceptives is idiosyncratic which means

Its unpredictable, not dose dependent

3

What type of cholestasis do we often see with oral contraceptives?

Bland cholestasis

4

Estrogen does what to Na/K ATPase and Bile Salt Transport

Decreases them

5

What is Budd Chiari syndrome?

Hepatic vein thrombosis...can be caused by oral contraceptives

6

What is Peliosis?

Blood filled venous lakes

7

So oral contraceptives can cause what types of liver complications?

- Vascular
- Budd Chiari
- Peliosis Hepasis
- Focal Nodular Hyperplasia- vascular injury on the arterial side

8

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

9

Hepatocellular carcinoma

rare

10

Always consider occupational chemical exposure

ok

11

polyvinyl chloride exposure, think...

angiosarcoma of the liver, very rare

12

Acetaminophen (Tylenol)

Increasing cause of acute liver failure...No cases were noted prior to 1980.

13

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

14

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

15

Alcoholics also have a revved up p450

ok

16

Acetaminophen is unsafe even in low doses in ppl with alcoholic liver disease

ok

17

Acetaminophen is well tolerated in ppl with non-alcoholic liver disease

ok

18

Even ppl with Cirrhosis from non-alcoholic causes are usually ok because they have low p450 and high glutathione levels

ok

19

What is the antedote

N-acetylcysteine

20

Treatment= No alcohol, no acetaminophen, give N-acetylcystein

ok

21

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...

22

Estrogen does what to membrane fluidity?

decreases it

23

Oral contraceptives typically induce what types of complication

vascular....including Budd Chiari, Peliosis hepatis, focal nodular hyperplasia

24

Eosinophils look like what

Bi-lobed nucleus w/ pink-red cytoplasm

25

you will see tons of inflammatory cells in drug induced liver failure

Eosinophils, lymphocytes -small round nucles, neutrophils, etc...