cirrhosis

Question 1

three main factors of cirrhosis

Answer 1

reduced liver blood flow
reduced metabolic function
reduced plasma proteins

Question 2

cirrhosis

Answer 2

small hard liver

Question 3

why is there portal hypertension

Answer 3

harder to pass through the liver

Question 4

portal hypertension give you __

Answer 4

varices veins in oesophagus

Question 5

caput medusae

Answer 5

the appearance of distended and engorged superficial epigastric veins, which are seen radiating from the umbilicus across the abdomen.

Question 6

what creates ascites

Answer 6

high portal pressure and low albumin

Question 7

first pass metabolism

Answer 7

The first pass effect is a phenomenon of drug metabolism whereby the concentration of a drug, specifically when administered orally, is greatly reduced before it reaches the systemic circulation.

Question 8

oral dose > IV dose

Answer 8

first pass

Question 9

first order metabolism

Answer 9

as plasma conc increases, metabolism increases

Question 10

zero-order metabolism

Answer 10

Zero-order kinetics is described when a constant amount of drug is eliminated per unit time but the rate is independent of the concentration of the drug.

Question 11

low albumin senses

Answer 11

low plasma volume

Question 12

what is renin secretion from the kindeys stimulated by?

Answer 12

low albumin

Question 13

what does a cirrhosed liver produce instead of aldosterone

Answer 13

secondary aldosteronism

Question 14

what hormones have an effect on cirrhosis

Answer 14

endothelia and oesotrogen

Question 15

angiotensin II

Answer 15

important vasoconstrictor

Question 16

what hormones cause sodium retention

Answer 16

angiotensin II, aldosterone, SNS

Question 17

aldosterone promotes

Answer 17

potassium loss

Question 18

what does ADH do

Answer 18

vasoconstrictor and promotes reabsorption of free water
effect: pull in more free water and dilutes blood = hyponatremia, increase sodium retention but more free water resteion = hypokalaemia

Question 19

water retention occurs with

Answer 19

ADH

Question 20

consequences of cirrhosis

Answer 20

gut oedema (poor absorption)
liver and kidney congestion (reduced function)
gross oedema and ascites
CHF

Question 21

what happens when liver is given NSAID

Answer 21

real PGE synthesis decrease (worst renal impairment, further sodium retention, risk of hepato-renal syndrome, worsening of CHF)
cirrhosis peptic ulcers increase (risk of GI bleed or perforation)

Question 22

NSAID or COX-2 inhibitor should always be co-prescribed with a ____ because it is ____

Answer 22

PPI, more cost effective

Question 23

when are phase I metabolised drugs affected

Answer 23

early

Question 24

when are phase II metaoblised drugs affected

Answer 24

late (these are preferred)

Question 25

paracetamol toxicity

Answer 25

not enough glutathione to counteract highly reactive intermediate

Question 26

paracetamol in liver disease

Answer 26

reduced glutathione stores longer half life increased P450 2E1 in alcoholics toxicity with normal doses

Question 27

Hy's rule

Answer 27

ALT/AST > 5 x ULN and bilirubin >3

Question 28

what does frusemide cause

Answer 28

diuretic causes reduced intra-vascular volume, hypokalaemia, hypomagnesaemia

Question 29

what does thiazide cause

Answer 29

hypokalaemia, hypomagnesaemia

Question 30

what does spironolactone cause

Answer 30

best drug with fluid restriction aim at 1kg/day weight loss

Question 31

superior mesenteric + splenic vein + gastric + part from inferior mesenteric = ?

Answer 31

portal vein

Question 32

portal vein carries outflow from what organs (5)

Answer 32

``` spleen oesophagul stomach pancreas small/large intestine ```

Question 33

what are the four collateral pathways

Answer 33

oesophageal and gastric venous plexus umbilical vein from the left portal vein to the epigastric venous system retroperitoneal collateral vessels the haemorrhoids venous plexus

Question 34

what are the pre-hepatic causes of portal hypertension

Answer 34

blockage of the portal vein before the liver; due to portal vein thrombosis or occlusion secondary to congenital portal venous abnormalities

Question 35

what are the intrahepatic causes of portal hypertension

Answer 35

due to distortion of the liver architecture, either presinusoidal or post sinusoidal