Chapter 7. Liver and Chronic Liver Diseases Flashcards
- Necrosis cellular breakdown drug example?
- Hepatocytes filled with small droplet of lipid. Abnormal retention of fat, liver primary organ of lipid metabolism. Deases and drug example.
- Acetaminophen
- Steatosis: Tetracycline’s
Drugs transportation into the bile from the liver.
- There are transporters for anions, bile salts, cations, and neutral organic compounds.
- Release small intestine.
Oral drugs passage to liver:
Mesenteric veins➡️portal veins➡️liver➡️hepatic vein➡️systemic
circulation
State some liver functions
Detoxification Blood glucose regulation Bile drainage Synthesis of a.a., proteins, vitamins and fats Blood circulation and filtration
Enterohepatic recirculation is recirculation bile from small intestine to liver. Further elaborate.
- This term refers to drugs emptied via bile into the small intestine and then reabsorbed from the intestinal lumen into the systemic circulation.
- It can allow the body to conserve endogenous substances such as bile acids, vitamins D and B12, estrogen etc. It may be responsible for some of the long half-lives of drugs.
How does antibiotic therapy interfere with the process of enterohepatic recirculation?
By drugs, which have been conjugated can be hydrolyzed by gut enzymes such as glucuronidase and then reabsorbed as the active drug or as a metabolite. A decrease in bacterial flora as a consequence of antibiotic therapy can decrease the amount of sulfatase and glucuronidase containing bacteria. This could then lead to an increased rate of elimination of the drug.
A condition in which obstruction of bile from liver to intestine, it is also referred to as?
Chronic Cholestasis (cholestasis jaundice, obstructive jaundice, or jaundice)
Give signs and symptoms for cholestasis.
- This drug removes excess of bilirubin from the body?
- Can be used for non-specific pruritus?
-Symptoms are pruritus (itching) and are due to hyperbilirubinemia associated with liver diseases. Yellow skin, eye, itchy skin. Abdominal pain, dark urine.
NO BLOODY STOOLS
-Cholestyramine
-Antihistamines
- This is a yellowish discoloration of skin and whites of eye caused by high levels of pigment bilirubin in the blood stream. -Explain why the urine appears dark?
- The other characteristic symptoms are pale stools and generalized itchiness.
- Jaundice
- The urine is dark because excessive bilirubin in blood excreted through kidney.
-The accumulation of fluid in peritoneal cavity and cause abdominal distention is referred to as
ascites, this is due to high plasma aldosterone levels.
-Give symptoms and infx pcauses.
- Ascites or Hydroperitoneum
- Abdominal distention, GI probs, TB
- Ascites is caused due to infections such as tuberculosis, heart failure, cirrhosis, and portal hypertension, and various cancers.
Give DOC for Ascites and explain.
Give alternate drug tx.
DOC is spironolactone is inhibitor of aldosterone, this hormone inc. Na/H2O retention.
Alternate furosemide can be added to enhance diuresis.
Condition in which brain function is impaired by presence of toxic
substances, absorbed from colon, which is normally detoxify and removed
by liver. This condition occurs in severe liver damage such as liver cirrhosis.
Hepatic Encephalopathy: (Porto Systemic Encephalopathy
Give symptoms and DOC for Hep. Ence.
- Symptoms include: Drowsiness, confusion, psychosis, difficulty in performing task (e.g. writing) and coma.
- DOC: lactulose for 2 to 3 bowel movement a day. If no improvement in 1 to 2 days add metronidazole.
Excessive copper disease?
DOC and taken together to counteract its effect.
Wilson’s disease.
-DOC penicillamine and tx is lifelong. -Pyridoxine (vitamin B6) 25 mg daily counteract its anti-pyridoxine effect
Avoid copper containing food such as?
-Avoid food that has high copper content such as peanuts, chocolate, shellfish, mushrooms, and
liver.
Destruction of normal liver tissue. permanent damage (IRREVERSIBLE) or scarring of the liver. Common cause is due to alcohol abuse. Give example of end stages of this disease.
Liver cirrhosis. End stage of chronic liver diseases, ascites, chronic hepatitis and hepatic encephalopaties.
Common and less comm. symptoms viral hepatits.
Most common symptoms: flue like symp. loss of appetite, fatigue, mild fever, muscle or joint aches, n and v.
Less comm symp: light colored stools, jaundice (yellowing of skin, and whites of the eye), generalized itching, internal bleeding, and altered mental state.
This is the most common hepatitis, 90% chronic in children and 5% in adults
What type of virus?
Hepatitis B- DNA type of virus, whereas others are RNA type.
acute hep. infection. How is this transmitted?
Hep. A vacc. is recommended to travelers.
Hep. A- transmits through food contaminations such as water or orofecal
B and C are chronic, how is it transmitted?
Transmission through body fluids, such as blood transfusion, sexual contact and sharing needles (drug abuse and spa).
This is often chronic in adults (this acute hep. 80% becomes chronic likely within first year of infection).
Give vaccine
Hep. C— no vaccine.
*Hep. B vacc also protects from D.
What is the drug of choice to treat acute viral hepatitis and chronic hepatitis?
Interferon alfa (IFN alfa)
Tx for each Hep. A, B, C
A- no tx
B- Interferon shots (4 mo), Lamivudine po (1yr), Adefovir po 2y
C- Peginterferon combination with antiviral ribavirin
DRUGS THAT CAN CAUSE HEPATOTOXICITY.
Give max doses.
Acetaminophen Tetracycline Methotrexate Vitamin A Salicylates
Iron Cyclophosphamide 6-Mercaptopurines
Acetaminophen- >4g dy Tetracycline- >2g dy Methotrexate- >25mg dy Vitamin A- chronic use over 40,000 U dy Salicylates- chronic use Iron- single dose >1g Cyclophosphamide 6-Mercaptopurines
- Inflamm of gall bladder.
- Chronic disease, history of fever, abdominal pain.
- Cholecystitis
- Bacterial peritonitis
- edema and congestion to severe infection with gangrene and perforation is an inflammation of gallbladder
- What is Cholestitis?
- Formation of gall stones?
- Cholecystitis
- Obstruction of bile secretion into duodenum from liver
- Cholelithiasis
What is a type of end stage chronic liver disease? What clinical laboratory tests are elevated?
Liver cirrhosis— AST
Hep B also protects what type of hepatitis and explain.
hepatitis B is a DNA type of virus. Whereas hepatitis D is RNA type of virus. However, hepatitis D to grow require assistance of hepatitis B is DNA. Thus by preventing hepatitis B, also prevents infection of hepatitis D.
