Study Group

What are the main functions of the liver?

Nutrient & vitamin metabolism; bile formation/secretion; detoxification; waste elimination; plasma protein synthesis; immunity

What are Phase 1 drug metabolism reactions?

Oxidation and hydroxylation

What are Phase 2 drug metabolism reactions?

Conjugation

What plasma proteins does the liver synthesize?

Albumin; clotting factors; steroid-binding proteins; acute-phase proteins

What immune roles does the liver have?

Sinusoids filter blood; Kupffer cells perform immune surveillance

What is DILI?

Liver damage caused by drugs or supplements

What lab criteria suggest DILI?

ALT >5x ULN; Alk Phos >2x ULN; ALT >3x ULN + bilirubin >2x ULN

What are risk factors for DILI?

Age; alcohol use; malnutrition; drug interactions; herbal supplements; genetics

What is direct DILI?

Predictable, dose-dependent toxicity (e.g., acetaminophen)

What is idiosyncratic DILI?

Unpredictable, rare reaction

What is indirect DILI?

Due to drug effects (e.g., immune changes, HBV reactivation)

What characterizes hepatocellular injury?

ALT/AST elevated more than Alk Phos

What characterizes cholestatic injury?

Alk Phos elevated more than ALT/AST

What is mixed liver injury?

Both hepatocellular and cholestatic elevations

What is the first step in DILI management?

Stop offending agent

What is the antidote for acetaminophen toxicity?

N-acetylcysteine (NAC)

Common causes of cirrhosis?

Alcohol; Hepatitis C; MASLD; autoimmune disease; medications

Key symptoms of cirrhosis?

Fatigue; jaundice; ascites; variceal bleeding; encephalopathy

Lab findings in cirrhosis?

Increased bilirubin, AST/ALT, INR; decreased platelets and albumin

Difference between compensated and decompensated cirrhosis?

Compensated = functional liver; decompensated = liver failure with complications

What is portal hypertension?

Increased portal venous pressure (>10 mmHg risk for varices)

First-line prophylaxis for varices?

Non-selective beta-blockers

Treatment for acute variceal bleeding?

Octreotide + ceftriaxone + procedures (TIPS if needed)

What is TIPS?

Shunt that bypasses liver to reduce portal pressure

First-line management of ascites?

Sodium restriction (<2 g/day)

Diuretics for ascites?

Spironolactone + furosemide

When is paracentesis used?

Large-volume ascites (>5 L)

Symptoms of SBP?

Fever; abdominal pain; altered mental status; leukocytosis

First-line SBP treatment?

Ceftriaxone or cefotaxime

SBP secondary prophylaxis?

Ciprofloxacin or Bactrim lifelong

Cause of hepatic encephalopathy?

Ammonia accumulation

First-line treatment for encephalopathy?

Lactulose

Add-on therapy for encephalopathy?

Rifaximin

Goal of lactulose therapy?

2-3 bowel movements/day

What does MELD score predict?

3-month survival

Components of MELD score?

Bilirubin; INR; creatinine; sodium; dialysis

When to consider liver transplant?

MELD >15 or complications

What is hepatorenal syndrome (HRS)?

Renal failure due to cirrhosis

Type 1 HRS?

Rapid, severe, poor prognosis

Type 2 HRS?

Slower, associated with refractory ascites

Definitive treatment for HRS?

Liver transplant

Stages of MASLD?

Fat accumulation → inflammation → fibrosis → cirrhosis

Risk factors for MASLD?

Obesity; T2DM; HTN; dyslipidemia

Gold standard diagnosis of MASLD?

Liver biopsy

First-line management of MASLD?

Weight loss (5-10%)

Only FDA-approved drug for MASLD?

Resmetirom

High-risk antibiotics for C. difficile?

Clindamycin; fluoroquinolones; cephalosporins

Other risk factors for C. difficile?

PPIs; advanced age; hospitalization

What type of virus causes Hepatitis A?

RNA virus

Does Hepatitis A become chronic?

No

How is Hepatitis A transmitted?

Fecal-oral

What does IgM anti-HAV indicate?

Active infection

What does IgG anti-HAV indicate?

Immunity

What type of virus causes Hepatitis B?

DNA virus

Transmission routes of Hepatitis B?

Blood; sexual; perinatal

Goal of Hepatitis B treatment?

Suppress viral replication

First-line drugs for Hepatitis B?

Tenofovir (TDF/TAF); entecavir