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957 Block 2 > 4. Liver Injury > Flashcards

4. Liver Injury Flashcards

1
Q

What is the location of the liver?

A

right upper quadrant

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2
Q

The liver receives __% of cardiac output.

A

25

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3
Q

What are the major blood vessels of the liver?

A

portal vein

hepatic artery

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4
Q

What are the 3 main functions of the liver?

A
  • energy metabolism
  • protein production
  • detoxification
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5
Q

What hepatic processes serve as energy metabolism?

A
  • gluconeogeneisis/ glycogenolysis

- cholesterol synthesis

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6
Q

What proteins are produced in the liver?

A
  • albumin

- coagulation factors

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7
Q

What processes are used for detoxification by the liver?

A
  • drug metabolism (phase I and II)
  • ammonia, urea cycle
  • synthesis of glutathione
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8
Q

What is the Phase I reaction?

A
  • oxidation
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9
Q

What is the Phase II reaction?

A

covalent attachment of the drug to a water-soluble carrier molecule

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10
Q

Acute liver failure occurs within ____ to _____.

A

days

weeks

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11
Q

What are some lab values that indicate acute liver failure?

A
  • elevated liver enzymes
  • high bilirubin
  • high INR (thin blood)
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12
Q

What is the diagnostic triad for acute liver failure?

A
  • < 26 weeks
  • INR greater than or equal to 1.5
  • encephalopathy
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13
Q

What are the signs and symptoms of chronic liver failure?

A
  • normal or slightly elevated AST, ALT

- minimal/ no symptoms until jaundice

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14
Q

Chronic liver failure is sometimes reversible. (T/F)

A

True

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15
Q

What is centrolobular necrosis?

A

direct or metabolite related hepatotoxicity

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16
Q

In centrolobular necrosis, damage spreads from _____ lobe and in an _______ direction.

A

middle

outward

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17
Q

What is a very common cause of centrolobular necrosis?

A

acetaminophen overdose

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18
Q

What is steatohepatitis?

A

an accumulation of fatty acids in hepatocytes

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19
Q

What is a common cause of steatohepatitis?

20
Q

What are the 2 subcategories of steatohepatitis?

A
  • Alcoholic fatty liver diseae

- Non-alcoholic steatohepatitis (NASH)

21
Q

What are some causes of NASH?

A
  • obesity

- drug induced (tetracycline, valproic acid)

22
Q

What is the cause of generalized hepatocellular necrosis?

A

autoimmune

23
Q

Generalized hepatocellular necrosis has a similar process to viral hepatitis. (T/F)

24
Q

What is cholestatic injury?

A

slowed bile flow through bile ducts

25
What are some lab values that indicate cholestatic injury?
high bilirubin and high alkaline phosphate are seen first, followed by increased liver enzymes
26
What are some main assessments that you must make about the patient in order to appropriately treat condition?
- medication/medical history - time frame - occupation - nutritional status
27
Diagnosis of liver injury is a diagnosis of _______.
exclusion
28
What are risk factors for liver injury?
- female - alcohol use - malnutrition - genetic
29
What could happen to a patient with inadequately treated liver injury?
- chronic liver disease - fulminant hepatic failure - death
30
What is the main treatment plan for liver injury?
- remove offending agent - antidote - dialysis - supportive care - liver transplant
31
What is a toxic acetaminophen dose for an adult?
7.5 - 10 g
32
What is a toxic acetaminophen dose for a child?
150 - 200 mg/kg
33
Acetaminophen is mainly metabolized via _________.
glucuronidation
34
A person overdoses on acetaminophen when ______ is depleted.
glutathione
35
The Rumack-Matthew nomogram can be used __ hours after ingestion.
4
36
The Rumack-Matthew nomogram is only used for long-term chronic exposure to acetaminophen. (T/F)
False: only for acute exposure
37
When is activated charcoal an appropriate treatment option for acetaminophen overdose?
within 4 hours of ingestion
38
When is activated charcoal NOT an appropriate treatment option for acetaminophen overdose?
- N/V prior to administration of charcoal | - lack of airway protection/ or altered mental status
39
What is the antidote to acetaminophen overdose?
N-acetylcysteine
40
N-acetylcystein is nearly 100% hepatoprotective if given ≥__ hours after ingestion.
8
41
What is the oral formulation of N-acetylcystein?
Mucomyst
42
What is the IV formulation of N-acetylcystein?
Acetadote
43
What is the loading dose for Mucomyst?
140 mg/kg
44
What is the maintenance dose for Mucomyst?
70 mg/kg q4h x 17 doses
45
What is the loading dose of Acetadote?
150 mg/kg
46
What is the 2nd dose of Acetadote?
50 mg/kg
47
What is the 3rd dose of Acetadote?
100 mg/kg

957 Block 2 (14 decks)

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