GI 6 Flashcards
What are short-term/acute effects of alcohol consumption?
- Accidents/violence
- Oesophagitis/gastritis
- Acute pancreatitis
- Aspiration
- Overdose
What are the long-term/chronic effects of alcohol consumption?
- Hypertension/cardiomyopathy/MI
- Stroke
- Neuropathies
- Cerebellar degeneration
- Dementia
- Problems with stomach, liver, pancreas
- Anaemia/bone marrow suppression
- Osteoporosis
- Endocrine/dermatologic/reproductive
What are the effects of foetal alcohol syndrome?
- Growth deficiency
- Mental retardation/intellectual impairment
- Attentional learning disabilities
- Behavioural problems
What are the 3 major effects of cirrhosis?
1) Reduced blood flow
2) Reduced metabolic function
3) Reduced plasma proteins
What would occur if NSAIDs were prescribed in liver disease?
- Worsen renal impairment -> risk of hepatorenal syndrome
- Worsening of CHF
- Peptic ulcers cause high risk of GI bleed and perforation
What would you need to do if prescribing a NSAID to a patient with liver disease?
Always co-prescribe with a PPI; but NSAIDs should be avoided at all costs
Are opiates safe to prescribe in liver disease?
All should be avoided or used sparingly (sedative opiates cause severe confusion and respiratory depression), fentanyl may be the only safe opiate
What occurs with prescription of paracetamol in liver disease?
- Reduced glutathione stores
- Toxic drug intermediates not inactivated
- Normal dose becomes dangerous
- A very low dose can be given
What is Hy’s law?
To identify is a patient is at a high risk of drug-induced liver injury:
- ALT/AST > 5xULN and
- Bilirubin > 3mg
Which diuretic should be used in liver disease for oedema and ascites?
Spirinolactone: best drug, with fluid restriction, aim at 1kg/day weight loss
How can sedation be achieved in encephalopathic liver disease?
Small doses of phase II metabolised benzodiazepines (Lorazepam, Oxazepam, Lormetazepam)
What antibiotics should be avoided in liver disease?
- Aminoglycosides nephrotoxic
- Quinolones epileptogenic
- Metronidazole reduced metabolism
What is fulminant hepatitis?
Fulminant hepatitis is a rare syndrome of massive necrosis of liver parenchyma and a decrease in liver size (acute yellow atrophy) that usually occurs after infection with certain hepatitis viruses, exposure to toxic agents, or drug-induced injury
When should you treat viral hepatitis?
- HCV RNA present and genotype known
- HBsAg and Hep B DNA present
- Hep B: raised ALT and high HBV DNA
- Chronic Hep C is treated right away (clinical priority)
What are the outcomes of liver injury?
- Very resistant to injury and large functional reserve
- Some can produce parenchymal necrosis but heal by restitution
- Some can leave permanent damage
What are the causes of acute onset of jaundice?
- Drugs
- Viruses
- Alcohol
- Bile duct obstruction
What are the 3 consequences of acute liver failure?
1) Complete recovery
2) Chronic liver disease
3) Death from liver failure
What are the different types of jaundice?
1) Pre-hepatic - too much haem breakdown
2) Hepatic - liver cells injured or dead
3) Post-hepatic - bile cannot escape into the bowel
What is cirrhosis of the liver?
Defined by bands of fibrosis separating regenerative nodules of hepatocytes; alteration of hepatic microvasculature
What are the complications of cirrhosis?
- Portal hypertension (-> oesophageal varices, caput medusa and haemorrhoids)
- Ascites
- Liver failure
What are the outcomes of alcoholic liver disease?
- Cirrhosis
- Portal hypertension (varices and ascites)
- Malnutrition
- Hepatocellular carcinoma
- Social disintegration
What is non-alcoholic steatohepatitis (NASH)?
- Non-drinkers
- Pathologically identical to alcoholic liver disease
- Occurs in patients with diabetes,obesity, hyperlipidaemia
- On the increase
- May lead to fibrosis and cirrhosis
What is chronic drug-induced hepatitis?
- Similar features to all other types of chronic hepatitis
- May trigger an autoimmune hepatitis
- Chronic active process
- Causes are too many to list
What are the storage diseases of the liver?
- Haemochromatosis
- Wilsons disease
- Alpha-1-antitrypsin deficiency
