18

Question 1

4 benifits of ursodiol

Answer 1

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

Question 2

when to use ursodiol

Answer 2

inflammatory and cholestatic disease

• has anti-inflammatory and makes bile move
• hyprophilic and prevents apoptosis

Question 3

Methionine is converted into — by MAT

Answer 3

SAMe

Question 4

SAMe has can increase hepatic — and prevent its depletion in the face of —

Answer 4

glutathione
toxic insult (acetaminophen/tylenol)

Question 5

SAMe goes through trans-sulfuration to form

Answer 5

glutathione
(cell detoxification)

Question 6

when to use SAMe

Answer 6

• acute liver disease: HL in cats, hepatotoxicity (both cause low glutathione- SAMe can form more)
• chronic liver disease

Question 7

benefits of milk thistle/silymarin

Answer 7

antioxidant- increases glutathione
antifibrotic
choleretic
anti-inflammatory
protection against mushroom toxicity

Question 8

when to use milk thistle

Answer 8

fibrosis
cholestasis
inflammatory
toxicity- mushroom

silymarin
* denamarin= SAMe and milk thistle

Question 9

benefit of vit E

Answer 9

antioxidant

Question 10

clinical signs of hepatic encephalopathy

Answer 10

head pressing
yelling
* bilateral cerebral cortical dysfunction

Question 11

two major ways to treat hepatic encephalopathy

Answer 11

decrease colonic protein load
prevent formation and absorption of ammonia

Question 12

how to decrease colonic protein load

Answer 12

• enema- making ammonia from protein in colon
• reduce dietary intake- dairy and vegis instead of meat or egg
• prevent GI hemorrhage- deworm, ulcer treatment

Question 13

how to prevent formation and absorption of ammonia that is causing hepatic encephalopathy

Answer 13

• antibiotics- kill microflora that is making ammonia from protein in gut (neomycin, metro)
• lactulose- enema or oral

Question 14

how does lactulose prevent hepatic encephalopathy

Answer 14

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

Question 15

how can liver disease cause gastric ulcers

Answer 15

portal hypertension will lead to decreased blood flow to GI tract= decreased protection to acid

Question 16

what causes ascites in liver pt

Answer 16

• decreased oncotic pressure from low albumin
• increased hydrostatic pressure from portal HTN

Question 17

how to treat ascites

Answer 17

low salt diet
diuretics: spironolactone
abdominocentesis

Question 18

two ways liver pt have coagulopathy

Answer 18

• decreased coag factor production
• decreased absorption of Vit K

Question 19

how to treat hepatic fibrosis

Answer 19

colchicine- can slow fibrosis, but GI side effect and BM suppression and $$$
prednisone, zinc?

Question 20

how to treat copper retention

Answer 20

• diet change
• chelation: D-penicillamine, Trientene
• decrease copper absorption- zinc salts, steroids, vit C