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PMY4004 > 6) Hepatic Disease > Flashcards

6) Hepatic Disease Flashcards

1
Q

What is the largest solid organ in the human body?

A

The liver.

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2
Q

What are the main lobes of the liver divided into?

A

Lobules.

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3
Q

How much blood does the liver receive per minute?

A

1.3L per minute.

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4
Q

What are the two main blood supplies to the liver?

A

Hepatic artery and hepatic portal vein.

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5
Q

What are the key functions of the liver?

A

Metabolism, synthesis, storage, immunity, and regulation of blood sugar.

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6
Q

What are the stages of liver disease?

A

Healthy liver, steatohepatitis, fibrosis, cirrhosis.

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7
Q

What is steatohepatitis?

A

Inflammation and accumulation of fat within hepatocytes.

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8
Q

What is hepatic fibrosis?

A

Scarring and collagen deposition due to continuous liver damage.

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9
Q

What are common causes of liver disease?

A
  • Alcohol
  • viral infections (Hepatitis A-E),
  • metabolic dysfunction,
  • drug-induced injury,
  • genetic disorders,
  • malignancy,
  • structural abnormalities.
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10
Q

What percentage of heavy drinkers develop cirrhosis?

A

About 10%.

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11
Q

What is the cornerstone treatment for alcohol-induced liver disease?

A

Abstinence from alcohol.

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12
Q

What is metabolic dysfunction-associated steatotic liver disease (MASLD)?

A

Triglyceride accumulation within hepatocytes due to obesity/overweight.

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13
Q

What are risk factors for drug-induced liver disease?

A

Gender, age, genetics, concurrent diseases, alcohol intake, drug formulation, polypharmacy.

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14
Q

What is the difference between intrinsic and idiosyncratic drug-induced liver reactions?

A
  • Intrinsic reactions are predictable, dose-dependent, and reproducible, while
  • idiosyncratic reactions are unpredictable, dose-independent, and variable in presentation.
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15
Q

What are signs and symptoms of liver disease?

A
  • Jaundice,
  • ascites,
  • bruising/bleeding,
  • portal hypertension,
  • encephalopathy,
  • pruritus,
  • fatigue,
  • weight loss,
  • gynaecomastia,
  • finger clubbing.
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16
Q

What is ascites?

A

Fluid accumulation in the peritoneal cavity due to impaired sodium excretion.

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17
Q

What is portal hypertension?

A

Increased pressure in the portal venous system due to liver damage.

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18
Q

What medication is used for prophylaxis of variceal bleeding in cirrhosis?

A

Propranolol.

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19
Q

What is hepatic encephalopathy?

A

A neuropsychiatric syndrome caused by accumulation of gut-derived toxins due to liver dysfunction.

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20
Q

What is the first-line treatment for hepatic encephalopathy?

A

Lactulose.

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21
Q

How does lactulose treat hepatic encephalopathy?

A

Lowers ammonia levels by acidifying colonic contents and promoting ammonia excretion.

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22
Q

What lab tests are important for assessing liver function?

A

ALT, AST, ALP, GGT, bilirubin, albumin, prothrombin time.

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23
Q

What is the Child-Pugh classification used for?

A

Assessing the severity of liver cirrhosis and predicting prognosis.

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24
Q

What five variables are included in the Child-Pugh score?

A

Ascites, encephalopathy, serum albumin, bilirubin, INR.

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25
Why should caution be used when prescribing opioids in hepatic impairment?
Increased risk of accumulation and CNS depression.
26
What drugs should be avoided or dose-adjusted in liver disease?
Opioids, NSAIDs, anticoagulants, nephrotoxic drugs, sedatives, antipsychotics, proton pump inhibitors.
27
Why is drug metabolism altered in hepatic impairment?
Reduced enzymatic activity affects drug clearance, increasing drug half-life and toxicity risk.
28
What is the primary function of the liver in metabolism?
Metabolism of carbohydrates, proteins, fats, hormones, vitamins, and drugs.
29
What is the role of the liver in protein synthesis?
Synthesizes plasma proteins, clotting factors, and amino acids.
30
What vitamins are stored in the liver?
Fat-soluble vitamins A, D, E, and K.
31
What are the two main classifications of liver disease?
Acute (lasting less than 6 months) and chronic (lasting more than 6 months).
32
What is the primary cause of alcoholic liver disease?
Excessive alcohol consumption leading to fatty liver, hepatitis, and cirrhosis.
33
What is the main difference between hepatitis and steatosis?
Hepatitis is liver inflammation, while steatosis is fat accumulation in hepatocytes.
34
What are the potential complications of cirrhosis?
Portal hypertension, varices, ascites, hepatic encephalopathy, hepatocellular carcinoma.
35
What is spontaneous bacterial peritonitis (SBP)?
Infection of ascitic fluid in cirrhotic patients, often requiring antibiotic treatment.
36
How does portal hypertension lead to varices?
Increased resistance in the liver causes blood to be redirected to collateral veins, leading to varices.
37
Why is propranolol used for variceal bleeding prophylaxis?
Reduces portal pressure by decreasing cardiac output and splanchnic blood flow.
38
What are the signs of hepatic encephalopathy?
Confusion, asterixis (flapping tremor), disorientation, somnolence, and coma in severe cases.
39
What dietary recommendations are given to patients with liver disease?
Low sodium diet for ascites, high-protein diet for hepatic encephalopathy prevention.
40
Why does hypoalbuminemia occur in liver disease?
Liver dysfunction reduces albumin synthesis, leading to edema and ascites.
41
What is the purpose of liver function tests?
Assess enzyme levels, bilirubin, and protein synthesis to evaluate liver health.
42
What does an elevated ALT indicate?
Liver cell damage, commonly seen in hepatitis and fatty liver disease.
43
What condition is associated with high ALP and GGT levels?
Cholestatic or obstructive liver disease.
44
What are common symptoms of cholestasis?
Pruritus, jaundice, pale stools, and dark urine due to impaired bile flow.
45
How does cholestyramine help relieve pruritus in liver disease?
Binds bile salts in the intestine, reducing their reabsorption and deposition in the skin.
46
What role does ammonia play in hepatic encephalopathy?
Excess ammonia crosses the blood-brain barrier, affecting neurological function.
47
Why should benzodiazepines be avoided in hepatic encephalopathy?
Increased sensitivity to CNS depressants due to impaired hepatic metabolism.
48
What are contraindications for NSAIDs in liver disease?
Increased risk of GI bleeding, nephrotoxicity, and sodium retention worsening ascites.
49
Why is warfarin use challenging in cirrhosis patients?
Liver dysfunction affects clotting factor synthesis, increasing bleeding risk.
50
What medications require dose adjustments in liver disease?
Benzodiazepines, opioids, anticoagulants, and drugs with high hepatic metabolism.
51
Why does hepatic impairment prolong drug half-life?
Reduced liver enzyme activity slows drug metabolism and clearance.
52
What drugs should be avoided in severe liver disease?
Methotrexate, sodium valproate, NSAIDs, aminoglycosides, and sedatives.
53
What is the significance of INR in liver disease?
Prolonged INR indicates impaired liver synthesis of clotting factors.
54
Why do patients with cirrhosis have increased bleeding tendencies?
Decreased clotting factor production and thrombocytopenia due to splenomegaly.
55
What is hepatocellular carcinoma (HCC)?
A primary liver cancer often associated with cirrhosis and chronic hepatitis B or C infection.
56
What is the most common cause of hepatocellular carcinoma worldwide?
Chronic hepatitis B infection.
57
What is the treatment for acute liver failure due to paracetamol overdose?
N-acetylcysteine (NAC) as an antidote to prevent hepatotoxicity.
58
What is the first-line treatment for hepatic encephalopathy and its mechanism?
Lactulose: acidifies the colon, traps ammonia (NH₃), and promotes excretion as ammonium (NH₄⁺).
59
How does rifaximin help in hepatic encephalopathy?
Rifaximin is a non-absorbed antibiotic that reduces ammonia-producing gut bacteria.
60
What are the grades of hepatic encephalopathy?
- Grade I: mood/sleep changes - Grade II: lethargy, slurred speech; - Grade III: confusion, somnolence; - grade IV: coma.
61
Which phase of drug metabolism is more affected in severe liver disease?
Phase I (CYP450 oxidation) is more impaired than Phase II (conjugation).
62
Why does propranolol require dose reduction in cirrhosis?
Due to increased bioavailability from reduced first-pass metabolism (porto-systemic shunting).
63
What is the mechanism of action of cholestyramine in cholestatic pruritus?
Binds bile salts in the gut to form an insoluble complex, which is excreted in the feces.
64
What types of drugs should be avoided in hepatic impairment?
Avoid drugs with narrow therapeutic index, high hepatic metabolism, long half-life, high protein binding.
65
Which types of drugs increase risk of hepatic encephalopathy?
Opioids and anticholinergics due to constipation risk; sedatives due to increased CNS sensitivity.
66
How does hypoalbuminaemia affect drug distribution in liver disease?
Increases free levels of protein-bound drugs, increasing toxicity risk.
67
What causes hepatic encephalopathy (HE) in liver disease?
Accumulation of CNS toxins (e.g., ammonia) due to impaired hepatic detoxification and disrupted blood-brain barrier.
68
What are common triggers of hepatic encephalopathy?
GI bleeding, infections, constipation, and high protein intake.
69
Why is lactulose used in hepatic encephalopathy?
It acidifies the colon, converts NH₃ to NH₄⁺, and promotes its excretion; aims for 2–3 soft stools/day.
70
Why might rifaximin be added to lactulose in hepatic encephalopathy?
To reduce gut bacteria that produce ammonia, especially in recurrent HE.
71
How does ascites affect drug pharmacokinetics?
It increases the volume of distribution for water-soluble drugs and delays gastric emptying.
72
How does liver disease affect protein-bound drugs?
Hypoalbuminaemia increases free drug levels, raising the risk of toxicity.
73
Which drug classes should be avoided in hepatic encephalopathy and why?
Opioids, sedatives, anticholinergics – they worsen constipation or increase CNS depression.
74
Why should NSAIDs be avoided in liver disease?
Increased bleeding risk due to coagulopathy and potential renal impairment.
75
What key advice should be given to patients and carers about hepatic encephalopathy?
Recognize early signs (confusion, lethargy), importance of adherence to lactulose/rifaximin, and notify DVLA due to driving restrictions.
76
How can pharmacists support patients with hepatic encephalopathy?
Clear explanation of disease, dosing guidance, managing side effects, and avoiding constipating or sedative drugs.

PMY4004 (9 decks)

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