18 Flashcards
4 benifits of ursodiol
hepatoprotective
* hydrophilic bile acid that will replace hydrophopic bile acids that can by cytotoxic
* improves bile flow
* immunomodulation- anti-inflammatory
* inhibits apoptosis of liver cells
when to use ursodiol
inflammatory and cholestatic disease
- has anti-inflammatory and makes bile move
- hyprophilic and prevents apoptosis
Methionine is converted into — by MAT
SAMe
SAMe has can increase hepatic — and prevent its depletion in the face of —
glutathione
toxic insult (acetaminophen/tylenol)
SAMe goes through trans-sulfuration to form
glutathione
(cell detoxification)
when to use SAMe
- acute liver disease: HL in cats, hepatotoxicity (both cause low glutathione- SAMe can form more)
- chronic liver disease
benefits of milk thistle/silymarin
antioxidant- increases glutathione
antifibrotic
choleretic
anti-inflammatory
protection against mushroom toxicity
when to use milk thistle
fibrosis
cholestasis
inflammatory
toxicity- mushroom
silymarin
* denamarin= SAMe and milk thistle
benefit of vit E
antioxidant
clinical signs of hepatic encephalopathy
head pressing
yelling
* bilateral cerebral cortical dysfunction
two major ways to treat hepatic encephalopathy
decrease colonic protein load
prevent formation and absorption of ammonia
how to decrease colonic protein load
- enema- making ammonia from protein in colon
- reduce dietary intake- dairy and vegis instead of meat or egg
- prevent GI hemorrhage- deworm, ulcer treatment
how to prevent formation and absorption of ammonia that is causing hepatic encephalopathy
- antibiotics- kill microflora that is making ammonia from protein in gut (neomycin, metro)
- lactulose- enema or oral
how does lactulose prevent hepatic encephalopathy
prevent formation and absorption of ammonia
* will be metabolized by colonic bacteria into organic acids, this will push ammonia ion formation instead of ammonia- ions can not be absorbed
* will increase GI transit time
how can liver disease cause gastric ulcers
portal hypertension will lead to decreased blood flow to GI tract= decreased protection to acid
what causes ascites in liver pt
- decreased oncotic pressure from low albumin
- increased hydrostatic pressure from portal HTN
how to treat ascites
low salt diet
diuretics: spironolactone
abdominocentesis
two ways liver pt have coagulopathy
- decreased coag factor production
- decreased absorption of Vit K
how to treat hepatic fibrosis
colchicine- can slow fibrosis, but GI side effect and BM suppression and $$$
prednisone, zinc?
how to treat copper retention
- diet change
- chelation: D-penicillamine, Trientene
- decrease copper absorption- zinc salts, steroids, vit C
