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Phase 2 GI and Surgery > 3. Liver Disease > Flashcards

3. Liver Disease Flashcards

1
Q

How is alcohol metabolised?

A

ethanol oxidised to acetaldehyde by alcohol dehydrogenase

acetaldehyde converted into acetate by acetaldehyde dehydrogenase

acetate is used by the peripheral tissues as part of cellular respiration

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2
Q

How are alcohol units calculated?

A

(volume of drink x ABV) ÷ 1000

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3
Q

A deficiency of what contributes to neurological manifestations of alcohol excess?

A

thiamin

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4
Q
  1. What drug is given to reduce alcohol withdrawal symptoms?

2. What drug is given to help maintain alcohol abstinence?

A
  1. chlordiazepoxide

2. acamprostate

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5
Q
  1. What do phase I reactions involve?

2. What do phase II reactions involve?

A
  1. oxidation/hydrolysis/reduction, facilitated by CP450 enzymes
  2. conjugation to make drugs more water soluble
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6
Q

What is hepatic clearance of oral drugs dependent on? (4)

A
  • efficiency of metabolising enzymes
  • hepatic blood flow
  • intrinsic clearance
  • protein binding
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7
Q

Name 5 risk factors for impaired hepatic drug metabolism

A
  • hepatocellular failure
  • decreased hepatic blood flow
  • decreased enzyme function
  • decreased protein binding
  • reduced bile production
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8
Q

Name 5 CP450 Inducers

A 
CRAPS out drugs
Carbamazepine
Rifampicin
barbituates
phenytoin
St John's Wort
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9
Q

Name 8 CP450 Inhibitors

A

some certain silly compounds annoyingly inhibit enzymes, grrr

Sodium valproate
Ciprofloxacin
Sulphonamide
Cimetidine
Antifungals; amiodarine
Isoniazind
Erythromycin
Grapefruit
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10
Q

When is jaundice clinically detectable (i.e. visualised?

A

Bilirubin >50

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11
Q

Describe how jaundice is classified

A

PREHEPATIC - haemolysis; defects in conjugation
HEPATIC - liver disease, drugs, toxins
POST-HEPATIC - obstruction of billiary tree

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12
Q

What is Gilbert’s Syndrome?

A
  • familial conjugated hyperbilirubinaemia
  • asymptomatic
  • mutations in enzyme responsible for bilirubin conjugation
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13
Q

What’s the difference between acute and chronic hepatits?

A

acute - resolves in ≥6 months

chronic - lasts ≥6 months

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14
Q

What are the clinical features of:

  1. acute hepatitis
  2. fulminant hepatitis
  3. Chronic hepatitis
A
  1. prodromal, non-specific flu like symptoms + jaundice, RUQ pain and hepatomegaly
  2. signs of acute hepatitis + coagulopathy + encephalopathy
  3. Signs of acute hepatitis + systemic inflammatory symptoms. Chronic onset
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15
Q

Describe the route of transmission and prognosis of the following types of viral hepatitis

  1. A
  2. B
  3. C
  4. D
  5. E
A
  1. faecal oral; never progresses to chronic disease
  2. transmitted via body fluids. can cause both acute and chronic hepatitis
  3. blood borne; becomes chronic in 70% of those infected (but remains asymptomatic for long periods)
  4. only occurs with hep B infection
  5. faecal oral; mostly acute. can be fulminant in pregnant women
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16
Q
  1. What is NAFLD?

2. What can it progress to?

A
  1. accumulation of fat (steatosis) in the liver due to causes other than alcohol
  2. NAFLD → non-alcoholic steatohepatitis → cirrhosis
17
Q

Name 3 investigations which can be performed for ?NAFLD

A
  1. ultrasound - demonstrates steatosis
  2. liver biopsy (for disease stage)
  3. elastography - used to evalulate the degree of fibrosis
18
Q

Briefly describe the pathogenesis of alcoholic liver disease

A
  1. metabolism of alcohol increases the NADH/NAD ratio in the liver; this alters the redox potential which drives hepatic fatty acid synthesis and decreased fatty acid oxidation. This results in the hepatic accumulation of fatty acid
19
Q

Describe the 3 stages of alcoholic liver disease

A
  1. steatosis - reversible with abstinence from alcohol
  2. alcoholic hepatitis - infiltration of leucocytes and hepatocyte necrosis
  3. cirrhosis - fibrosis (which disrupts hepatic blood flow); irreversible
20
Q

Name the complications of cirrhosis (6) which patients typically present with

A
  1. ascities
  2. oesophageal varices
  3. hepatic encephalopathy
  4. hepatorenal syndrome
  5. hepatopulmonary syndrome
  6. Hepatocellular carcinoma
21
Q

Investigations for Alcoholic Liver Disease (5)

A
  1. LFTs
  2. ultrasound
  3. CT
  4. Liver biopsy and histology
  5. elastography
22
Q

How is alcoholic liver disease managed? (4)

A
  1. abstience from alcohol
  2. bed rest
  3. high protein diet and vitamin supplimentation
  4. liver transplant for cirrhosis
23
Q

What scoring system is used to assess severity of Cirrhosis?

A

Child’s-Pugh Classification

24
Q
  1. What should be avoided in patients with cirrhosis? (3)
  2. What screening should people with cirrhosis undergo?
  3. What diet is recommended for patient’s with cirrhosis?
A
  1. alcohol, NSAIDs, aspirin
  2. 6 monthly ultrasound to detect early hepatocellular carcinoma
  3. reduced salt
25
Q
  1. What is the eligibility criteria for liver transplantation?
  2. Name 4 contraindications for liver transplant
A
  1. must be abstinent from alcohol for 6+ months and/or must not be continuing to use intravenous drugs
  2. active sepsis outside the hepatobiliary tree
    malignancy outside the liver
    liver mets
    lack of psychological commitment on the part of the patient
26
Q
  1. What is budd-chiari syndrome?

2. Name 4 causes of budd chiari syndrome

A
  1. obstruction to the venous outflow of the liver because of hepatic vein occlusion
  2. idiopathuc
    hypercoagulability
    thrombophillia
    occlusion of the hepatic vein secondary to tumours

Phase 2 GI and Surgery (10 decks)

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