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Questions and Answers
Which medication can cause cholestasis without hepatitis and is more common in men than women?
Which medication can cause cholestasis without hepatitis and is more common in men than women?
What is the fatal dose threshold for Acetaminophen in cases involving suicide attempts?
What is the fatal dose threshold for Acetaminophen in cases involving suicide attempts?
Which marker of hepatocellular injury is liver-specific?
Which marker of hepatocellular injury is liver-specific?
Which of the following has the potential to stimulate the immune system and cause autoimmune diseases?
Which of the following has the potential to stimulate the immune system and cause autoimmune diseases?
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What is a common feature of Hepatocellular injuries caused by Methotrexate?
What is a common feature of Hepatocellular injuries caused by Methotrexate?
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What liver marker is elevated in cholestasis?
What liver marker is elevated in cholestasis?
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Which marker can indicate alcohol abuse or liver disease?
Which marker can indicate alcohol abuse or liver disease?
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Which factor can be protective against fatal Acetaminophen overdoses in chronic alcohol users?
Which factor can be protective against fatal Acetaminophen overdoses in chronic alcohol users?
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What does urine bilirubin directly reflect?
What does urine bilirubin directly reflect?
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In what situation are immune checkpoint inhibitors most likely to require treatment pause?
In what situation are immune checkpoint inhibitors most likely to require treatment pause?
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Which liver injury marker can also indicate growing placenta and growing bone?
Which liver injury marker can also indicate growing placenta and growing bone?
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What is a characteristic symptom onset of cholestasis with hepatitis induced by certain antibiotics?
What is a characteristic symptom onset of cholestasis with hepatitis induced by certain antibiotics?
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What does elevated total serum bilirubin not precisely indicate?
What does elevated total serum bilirubin not precisely indicate?
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Which liver marker is present in many tissues besides the liver?
Which liver marker is present in many tissues besides the liver?
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Which enzyme is the primary enzyme responsible for converting ethanol to acetaldehyde?
Which enzyme is the primary enzyme responsible for converting ethanol to acetaldehyde?
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What is a common toxic effect of acetaldehyde on cells?
What is a common toxic effect of acetaldehyde on cells?
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Which area of the liver is especially prone to hypoxia due to alcohol consumption?
Which area of the liver is especially prone to hypoxia due to alcohol consumption?
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What are Canada's low-risk alcohol drinking guidelines for women?
What are Canada's low-risk alcohol drinking guidelines for women?
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Which enzyme elevation ratio is typically seen in acute alcohol-related hepatitis?
Which enzyme elevation ratio is typically seen in acute alcohol-related hepatitis?
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What is a common symptom associated with acute alcohol-related hepatitis?
What is a common symptom associated with acute alcohol-related hepatitis?
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Which laboratory finding is indicative of possible cirrhosis in acute alcohol-related hepatitis?
Which laboratory finding is indicative of possible cirrhosis in acute alcohol-related hepatitis?
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What is a common culprit of drug-induced liver injury (DILI) that responds to corticosteroids?
What is a common culprit of drug-induced liver injury (DILI) that responds to corticosteroids?
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In hepatocellular injuries, which enzyme levels are typically higher than ALP?
In hepatocellular injuries, which enzyme levels are typically higher than ALP?
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What is the R value used for in the context of liver injuries?
What is the R value used for in the context of liver injuries?
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What is a common culprit of cholestatic liver injury with elevated ALP levels?
What is a common culprit of cholestatic liver injury with elevated ALP levels?
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What is a key difference between immune drug-induced liver injury (DILI) and autoimmune DILI?
What is a key difference between immune drug-induced liver injury (DILI) and autoimmune DILI?
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What outcome can chronic alcohol use lead to in the liver?
What outcome can chronic alcohol use lead to in the liver?
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Why is re-challenge with the same offending drug not recommended in managing drug-induced liver injury (DILI)?
Why is re-challenge with the same offending drug not recommended in managing drug-induced liver injury (DILI)?
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Which type of DILI affects susceptible individuals and has variable exposure and presentation?
Which type of DILI affects susceptible individuals and has variable exposure and presentation?
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What is the mechanism of non-immune DILI?
What is the mechanism of non-immune DILI?
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Which common culprits are associated with non-immune DILI?
Which common culprits are associated with non-immune DILI?
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What distinguishes immune DILI from non-immune DILI?
What distinguishes immune DILI from non-immune DILI?
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What mechanism is involved in immune DILI?
What mechanism is involved in immune DILI?
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How soon can immune DILI symptoms typically occur after drug exposure?
How soon can immune DILI symptoms typically occur after drug exposure?
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Which syndrome can precede the development of immune DILI?
Which syndrome can precede the development of immune DILI?
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What distinguishes autoimmune DILI from other types?
What distinguishes autoimmune DILI from other types?
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What can trigger autoimmune DILI?
What can trigger autoimmune DILI?
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Which type of DILI may recur after rechallenge with the same drug?
Which type of DILI may recur after rechallenge with the same drug?
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In drug-induced liver injuries (DILI), what is the primary role of AST and ALT enzymes?
In drug-induced liver injuries (DILI), what is the primary role of AST and ALT enzymes?
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Which enzyme marker can indicate both cholestasis and hepatocellular injury?
Which enzyme marker can indicate both cholestasis and hepatocellular injury?
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What can isolated elevated GGT levels in a patient indicate?
What can isolated elevated GGT levels in a patient indicate?
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Which liver enzyme is a marker of cholestasis and can be regurgitated into the serum from damaged liver cells?
Which liver enzyme is a marker of cholestasis and can be regurgitated into the serum from damaged liver cells?
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What does elevated urine bilirubin directly reflect in terms of liver health?
What does elevated urine bilirubin directly reflect in terms of liver health?
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Which liver marker is liver-specific and not as commonly found in other cells?
Which liver marker is liver-specific and not as commonly found in other cells?
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In liver injuries, what does an elevated total serum bilirubin not precisely indicate?
In liver injuries, what does an elevated total serum bilirubin not precisely indicate?
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Which type of drug-induced liver injury (DILI) is characterized by a reaction that includes rash, fever, and joint pain?
Which type of drug-induced liver injury (DILI) is characterized by a reaction that includes rash, fever, and joint pain?
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What can be a distinguishing feature between immune DILI and non-immune DILI?
What can be a distinguishing feature between immune DILI and non-immune DILI?
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Which common symptom is associated with immune DILI but is absent in non-immune DILI?
Which common symptom is associated with immune DILI but is absent in non-immune DILI?
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What is a characteristic symptom of non-immune DILI that differentiates it from immune DILI?
What is a characteristic symptom of non-immune DILI that differentiates it from immune DILI?
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Which type of drug-induced liver injury (DILI) involves the binding of drug metabolites to proteins, lipids, enzymes, or DNA causing oxidative stress?
Which type of drug-induced liver injury (DILI) involves the binding of drug metabolites to proteins, lipids, enzymes, or DNA causing oxidative stress?
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Which type of liver injury can develop several weeks after discontinuation of the causative drug?
Which type of liver injury can develop several weeks after discontinuation of the causative drug?
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What is the typical enzyme level pattern in cholestatic liver injuries?
What is the typical enzyme level pattern in cholestatic liver injuries?
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Which enzyme elevation ratio is indicative of hepatocellular liver injury over cholestatic injury?
Which enzyme elevation ratio is indicative of hepatocellular liver injury over cholestatic injury?
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What is the common feature of autoimmune DILI compared to other types of DILI?
What is the common feature of autoimmune DILI compared to other types of DILI?
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What is a distinguishing factor between immune DILI and autoimmune DILI?
What is a distinguishing factor between immune DILI and autoimmune DILI?
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Which common drug culprit is associated with cholestatic liver injury and elevated ALP levels?
Which common drug culprit is associated with cholestatic liver injury and elevated ALP levels?
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What enzyme level pattern is typically seen in hepatocellular liver injuries?
What enzyme level pattern is typically seen in hepatocellular liver injuries?
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Which characteristic symptom onset is suggestive of hepatocellular liver injury induced by certain antibiotics?
Which characteristic symptom onset is suggestive of hepatocellular liver injury induced by certain antibiotics?
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What is a common characteristic symptom of acute alcohol-related hepatitis?
What is a common characteristic symptom of acute alcohol-related hepatitis?
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Which enzyme ratio elevation is typically observed in acute alcohol-related hepatitis?
Which enzyme ratio elevation is typically observed in acute alcohol-related hepatitis?
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What is a common indicator of possible cirrhosis in acute alcohol-related hepatitis cases?
What is a common indicator of possible cirrhosis in acute alcohol-related hepatitis cases?
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Which type of liver injury marker is typically elevated in cholestasis?
Which type of liver injury marker is typically elevated in cholestasis?
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Which symptom can be indicative of cholestasis with hepatitis induced by certain antibiotics?
Which symptom can be indicative of cholestasis with hepatitis induced by certain antibiotics?
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In hepatocellular injuries, which enzyme level is typically higher than ALP?
In hepatocellular injuries, which enzyme level is typically higher than ALP?
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What distinguishes immune drug-induced liver injury (DILI) from autoimmune DILI?
What distinguishes immune drug-induced liver injury (DILI) from autoimmune DILI?
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Which type of liver injury presents with cholestasis but without hepatitis and is more common in men than women?
Which type of liver injury presents with cholestasis but without hepatitis and is more common in men than women?
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What liver enzyme levels are typically high in cases of cholestatic liver injury with hepatitis?
What liver enzyme levels are typically high in cases of cholestatic liver injury with hepatitis?
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Which medication is associated with cholestatic liver injury with hepatitis where the symptom onset can occur several weeks after use?
Which medication is associated with cholestatic liver injury with hepatitis where the symptom onset can occur several weeks after use?
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In which type of liver injury are the bilirubin levels typically over 20 times the upper limit of normal (ULN)?
In which type of liver injury are the bilirubin levels typically over 20 times the upper limit of normal (ULN)?
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Which drug class has the potential to stimulate the immune system and cause autoimmune diseases?
Which drug class has the potential to stimulate the immune system and cause autoimmune diseases?
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What symptomatology can be expected in cases of immune Drug-Induced Liver Injury (DILI) that requires treatment pause?
What symptomatology can be expected in cases of immune Drug-Induced Liver Injury (DILI) that requires treatment pause?
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Which liver marker is liver-specific and indicates hepatocellular injury?
Which liver marker is liver-specific and indicates hepatocellular injury?
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Study Notes
Cholestasis and Hepatic Injury
- Cholestasis without Hepatitis: Certain medications can induce cholestasis without liver inflammation; this condition is more prevalent in men compared to women.
- Acetaminophen Fatal Dose: The threshold for a fatal Acetaminophen overdose in suicide attempts is markedly low, necessitating caution in overdose situations.
- Liver-Specific Injury Marker: Alanine aminotransferase (ALT) is a key liver-specific enzyme indicative of hepatocellular damage.
Immune Response and Hepatotoxicity
- Immune System Stimulation: Certain drug classes can trigger immune responses, potentially leading to autoimmune diseases.
- Methotrexate Injuries: Common manifestations of hepatocellular injury linked to Methotrexate revolve around specific biochemical markers.
Cholestasis Markers
- Cholestasis Liver Marker: Alkaline phosphatase (ALP) is elevated in cases of cholestasis.
- Alcohol Abuse Indicator: Gamma-glutamyl transferase (GGT) serves as a marker for alcoholism and liver disease.
Protective Factors Against Overdose
- Chronic Alcohol Users Protection: Chronic alcohol use may confer some level of resilience against the lethal outcomes of Acetaminophen toxicity.
Bilirubin Insights
- Urine Bilirubin Reflection: The presence of bilirubin in urine directly indicates liver function and potential dysfunction.
- Total Serum Bilirubin Caveat: Elevated total serum bilirubin levels do not distinctly indicate liver injury severity or type.
Checkpoint Inhibitors and Treatment Management
- Treatment Pause for Checkpoint Inhibitors: Immune checkpoint inhibitors may necessitate treatment pauses in patients experiencing significant liver injury or hypoxic conditions.
Growing Tissue Indicators
- Marker in Pregnancy: Lactate dehydrogenase (LDH) can indicate liver stress and is also found in the placenta and growing bone.
Symptoms and Characteristics
- Cholestasis with Hepatitis Onset: Certain antibiotics can cause cholestasis with a delayed onset of symptoms.
- Acute Alcohol-Related Hepatitis Symptoms: Common clinical features include abdominal pain and nausea, which arise rapidly in acute cases.
Cirrhosis Indications
- Cirrhosis Lab Findings: Laboratory evidence such as elevated liver enzymes can suggest potential cirrhosis in those with acute alcohol-related hepatitis.
Drug-Induced Liver Injury (DILI)
- Corticosteroid Response for DILI: Corticosteroids are often effective for treating drug-induced liver injury associated with specific culprits.
- Enzyme Patterns in Hepatocellular Injury: In hepatocellular injuries, AST and ALT enzyme levels are usually higher than ALP.
R Value Usage
- R Value in Liver Injury: The R value evaluates the relative elevation of liver enzymes to differentiate injury types during assessment.
Non-Immune vs Immune DILI
- Culprit Drugs in Non-Immune DILI: Common offenders include NSAIDs and certain antibiotics, causing variable liver damage.
- Immune DILI Mechanism: Involves a hypersensitivity reaction marked by quicker symptom onset after drug exposure.
Autoimmune DILI Characteristics
- Autoimmune DILI Triggers: Various factors can instigate autoimmune DILI, often with distinct symptom profiles.
- Clinical Features of Autoimmune DILI: Patients may display classical systemic symptoms including rash and arthralgia.
Drug Rechallenge Risks
- Caution with Rechallenge: Re-exposure to previously offending drugs in DILI management is not advisable due to risk of recurrence.
Enzyme Ratios and Patterns
- Enzyme Level Ratios in Hepatocellular vs Cholestatic Injury: A higher AST/ALT ratio signifies hepatocellular injury, while ALP elevation is prominent in cholestatic injury.
- Urine Bilirubin as an Indicator: Its elevation indicates ongoing liver dysfunction and possible cholestasis.
Symptomatic Differences in DILI Types
- Symptomatology Contrast: Features differentiating immune DILI from non-immune types include unique symptoms like rash and joint pain present in immune DILI.
Alcohol Consumption Guidelines
- Canadian Drinking Guidelines: Women are advised to adhere to lower-risk drinking guidelines to prevent liver-related health issues associated with alcohol.
Hypoxia Risks
- Liver Regions and Alcohol: The zone closest to central veins in the liver risks hypoxia, especially in chronic alcohol users due to blood flow dynamics.
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Description
This quiz covers the functions and levels of AST, ALT, and ALP enzymes in the liver. Learn about their roles as markers of hepatocellular injury, gluconeogenesis, cholestasis, and liver damage.
