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Which of the following halogenated agents is NOT associated with fulminant autoimmune hepatitis? | Which of the following halogenated agents is NOT associated with fulminant autoimmune hepatitis? | ||
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E. Isoflurane | E. Isoflurane | ||
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==Answer== | ==Answer== | ||
The answer is B. The first large study on halothane-associated liver injury reported an incidence of 1:35,000 for fatal hepatic necrosis after halothane anesthesia. Patients are thought to be at higher risk after repeated exposures. This is in contrast to a MILD form of hepatocelluar injury than can occur in 20% of patients after halothane anesthesia. The mild form involves a transient elevation in liver enzymes (ALT) and slight alterations in cellular integrity by electron microscopy. The metabolism of halogenated agents causes tissue acetylation. Antibodies against these neo-antigens is thought to be the mechanism of the severe type of hepatic injury. The onset for the severe type occurs at 4-7 days and is usually present with jaundice and fever. Enflurane, isoflurane, halothane, and desflurane have been reported to trigger this fulminant type. As sevoflurane is metabolized by a distinctly different pathway than the agents with a methyl-ethyl structure, the autoimmune response is not known to occur. The MILD injury can still occur. | The answer is B. The first large study on halothane-associated liver injury reported an incidence of 1:35,000 for fatal hepatic necrosis after halothane anesthesia. Patients are thought to be at higher risk after repeated exposures. This is in contrast to a MILD form of hepatocelluar injury than can occur in 20% of patients after halothane anesthesia. The mild form involves a transient elevation in liver enzymes (ALT) and slight alterations in cellular integrity by electron microscopy. The metabolism of halogenated agents causes tissue acetylation. Antibodies against these neo-antigens is thought to be the mechanism of the severe type of hepatic injury. The onset for the severe type occurs at 4-7 days and is usually present with jaundice and fever. Enflurane, isoflurane, halothane, and desflurane have been reported to trigger this fulminant type. As sevoflurane is metabolized by a distinctly different pathway than the agents with a methyl-ethyl structure, the autoimmune response is not known to occur. The MILD injury can still occur. | ||
==Notes== | ==Notes== | ||
<references /> | <references /> | ||
==Keywords== | ==Keywords== | ||
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