72 Questions
Which medication can cause cholestasis without hepatitis and is more common in men than women?
Anabolic Steroids
What is the fatal dose threshold for Acetaminophen in cases involving suicide attempts?
> 15g
Which marker of hepatocellular injury is liver-specific?
ALT
Which of the following has the potential to stimulate the immune system and cause autoimmune diseases?
Herbal Products
What is a common feature of Hepatocellular injuries caused by Methotrexate?
Normal transaminases and high bilirubin levels
What liver marker is elevated in cholestasis?
ALP
Which marker can indicate alcohol abuse or liver disease?
GGT
Which factor can be protective against fatal Acetaminophen overdoses in chronic alcohol users?
Concomitant medications that inhibit CYP enzymes
What does urine bilirubin directly reflect?
Hyperbilirubinemia
In what situation are immune checkpoint inhibitors most likely to require treatment pause?
When there is jaundice with high bilirubin levels
Which liver injury marker can also indicate growing placenta and growing bone?
ALP
What is a characteristic symptom onset of cholestasis with hepatitis induced by certain antibiotics?
Can occur several weeks after antibiotic use
What does elevated total serum bilirubin not precisely indicate?
Liver damage
Which liver marker is present in many tissues besides the liver?
GGT
Which enzyme is the primary enzyme responsible for converting ethanol to acetaldehyde?
CYP 2E1
What is a common toxic effect of acetaldehyde on cells?
Mitochondrial dysfunction
Which area of the liver is especially prone to hypoxia due to alcohol consumption?
Centrilobular area
What are Canada's low-risk alcohol drinking guidelines for women?
< 2 drinks / day, < 10 drinks / week
Which enzyme elevation ratio is typically seen in acute alcohol-related hepatitis?
2:1 - 3:1
What is a common symptom associated with acute alcohol-related hepatitis?
RUQ pain
Which laboratory finding is indicative of possible cirrhosis in acute alcohol-related hepatitis?
Hyperbilirubinemia
What is a common culprit of drug-induced liver injury (DILI) that responds to corticosteroids?
Minocycline
In hepatocellular injuries, which enzyme levels are typically higher than ALP?
ALT & AST
What is the R value used for in the context of liver injuries?
Classifying liver injury as hepatocellular or cholestatic
What is a common culprit of cholestatic liver injury with elevated ALP levels?
Amiodarone
What is a key difference between immune drug-induced liver injury (DILI) and autoimmune DILI?
Relapse can occur after drug withdrawal in immune DILI but not in autoimmune DILI
What outcome can chronic alcohol use lead to in the liver?
All of the above
Why is re-challenge with the same offending drug not recommended in managing drug-induced liver injury (DILI)?
There is a risk of severe exacerbation or recurrence of DILI
Which type of DILI affects susceptible individuals and has variable exposure and presentation?
Idiosyncratic DILI
What is the mechanism of non-immune DILI?
Oxidative stress from metabolites binding to proteins, lipids, enzymes, or DNA
Which common culprits are associated with non-immune DILI?
Amiodarone, diclofenac, isoniazid
What distinguishes immune DILI from non-immune DILI?
Hypersensitive reaction with rash, fever, joint pain, eosinophilia
What mechanism is involved in immune DILI?
Haptenization causing direct toxicity
How soon can immune DILI symptoms typically occur after drug exposure?
1-8 weeks
Which syndrome can precede the development of immune DILI?
'Mono'-like syndrome
What distinguishes autoimmune DILI from other types?
Characterized by an aberrant immune response against liver cells
What can trigger autoimmune DILI?
Viral infections or other autoimmune diseases
Which type of DILI may recur after rechallenge with the same drug?
Immune DILI
In drug-induced liver injuries (DILI), what is the primary role of AST and ALT enzymes?
Indicate hepatocellular injury
Which enzyme marker can indicate both cholestasis and hepatocellular injury?
ALP
What can isolated elevated GGT levels in a patient indicate?
Alcohol abuse
Which liver enzyme is a marker of cholestasis and can be regurgitated into the serum from damaged liver cells?
ALP
What does elevated urine bilirubin directly reflect in terms of liver health?
Cholestasis
Which liver marker is liver-specific and not as commonly found in other cells?
ALT
In liver injuries, what does an elevated total serum bilirubin not precisely indicate?
Hepatocellular damage
Which type of drug-induced liver injury (DILI) is characterized by a reaction that includes rash, fever, and joint pain?
Autoimmune DILI
What can be a distinguishing feature between immune DILI and non-immune DILI?
Presence of fever and rash
Which common symptom is associated with immune DILI but is absent in non-immune DILI?
Mononucleosis-like syndrome
What is a characteristic symptom of non-immune DILI that differentiates it from immune DILI?
Reoccurrence after rechallenge
Which type of drug-induced liver injury (DILI) involves the binding of drug metabolites to proteins, lipids, enzymes, or DNA causing oxidative stress?
Non-immune DILI
Which type of liver injury can develop several weeks after discontinuation of the causative drug?
Non-immune DILI
What is the typical enzyme level pattern in cholestatic liver injuries?
ALP > ALT & AST
Which enzyme elevation ratio is indicative of hepatocellular liver injury over cholestatic injury?
R > 5
What is the common feature of autoimmune DILI compared to other types of DILI?
Re-challenge can be considered
What is a distinguishing factor between immune DILI and autoimmune DILI?
Eosinophilia on liver biopsies
Which common drug culprit is associated with cholestatic liver injury and elevated ALP levels?
Amoxicillin
What enzyme level pattern is typically seen in hepatocellular liver injuries?
ALT > ALP & AST
Which characteristic symptom onset is suggestive of hepatocellular liver injury induced by certain antibiotics?
Granulomatous inflammation on liver biopsies
What is a common characteristic symptom of acute alcohol-related hepatitis?
RUQ pain
Which enzyme ratio elevation is typically observed in acute alcohol-related hepatitis?
2:1
What is a common indicator of possible cirrhosis in acute alcohol-related hepatitis cases?
Hyperbilirubinemia
Which type of liver injury marker is typically elevated in cholestasis?
ALP
Which symptom can be indicative of cholestasis with hepatitis induced by certain antibiotics?
Jaundice
In hepatocellular injuries, which enzyme level is typically higher than ALP?
AST
What distinguishes immune drug-induced liver injury (DILI) from autoimmune DILI?
The involvement of T cells
Which type of liver injury presents with cholestasis but without hepatitis and is more common in men than women?
Anabolic Steroids-induced cholestatic injury
What liver enzyme levels are typically high in cases of cholestatic liver injury with hepatitis?
High transaminases, ALP, GGT
Which medication is associated with cholestatic liver injury with hepatitis where the symptom onset can occur several weeks after use?
Fluoroquinolones
In which type of liver injury are the bilirubin levels typically over 20 times the upper limit of normal (ULN)?
Amoxicillin-Clavulanate-induced cholestatic injury
Which drug class has the potential to stimulate the immune system and cause autoimmune diseases?
Immune Check Point Inhibitors
What symptomatology can be expected in cases of immune Drug-Induced Liver Injury (DILI) that requires treatment pause?
Jaundice with high bilirubin levels
Which liver marker is liver-specific and indicates hepatocellular injury?
Aspartate aminotransferase (AST)
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.
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