Hepatic and Renal Disease (Final Exam)

Question 1

What are the 3 blood levels that measure liver enzyme activities?

Answer 1

Alanine Aminotransferase (ALT)
Alkaline Phosphatase (ALP)
Aspartate Aminotransferase (AST)

Question 2

Define: ALT

Answer 2

Alanine Aminotransferase
Highest concentration in liver cells
Increased activities suggest leakage or necrosis of liver cells`

Question 3

Define: ALP

Answer 3

Alkaline Phosphatase
Highest concentration in epithelium of the biliary tree
Increased activities suggest cholestasis of bile
There is also an inducible isoform, and it is also present in other tissues (kidney, bone, placenta) so NOT liver specific

Question 4

Define: AST

Answer 4

Aspartate Aminotransferase
Mitochondrial location, also present in high concentrations in the muscle

Question 5

What are the pseudo liver function tests? How do these values change with liver failure?

Answer 5

Blood urea nitrogen (BUN)
Albumin
Glucose
Cholesterol
Decrease with liver failure

Question 6

What is the preferred, easiest, and best liver function test?

Answer 6

Pre and post-prandial bile acids
[Hard to interpret if bilirubin is already elevated]

Question 7

What are the 3 bilirubin concentration levels?

Answer 7

Pre-hepatic (hemolytic anemias)
Hepatic
Post-hepatic (obstruction outside the liver parenchyma)

Question 8

What are the (5) goals of dietary management of liver disease?

Answer 8

1. Make a primary diagnosis and treat
2. Supply adequate nutrients to avoid malnutrition
3. Limit further injury by lessening copper accumulation and free radicals
4. Support hepatocellular regeneration
5. Minimize metabolic complications (hepatic encephalopathy, ascites)

Question 9

What (5) components should a commercial diet include to manage liver disease?

Answer 9

Energy
Fiber
Protein
Vitamins, Minerals
Anti-oxidants

Question 10

Dietary Management of Liver Disease: Protein

Answer 10

High quality
Highly digestible
Low in copper
>20% of dietary calories
Restrict only in hepatic encephalopathy

Question 11

Dietary Management of Liver Disease: Fiber

Answer 11

Moderate amounts
Preferably soluble [effect on bacterial overgrowth, lessens NH3 absorption which may lessen hepatic encephalopathy]

Question 12

Dietary Management of Liver Disease: Vitamins & Minerals

Answer 12

Increased Vitamin B
Increased Vitamin E [anti-oxidant]
Moderate sodium restriction [lessens ascites]
Adequate potassium
Restrict copper [lessens accumulation]

Question 13

Dietary Management of Liver Disease: Anti-Oxidants

Answer 13

Increased Zinc
Increased Vitamin E
Increased Vitamin C
Increased Taurine

Question 14

Dietary Management of Liver Disease: Energy

Answer 14

High palatability
High energy density
Small frequent meals
Fat [20-50% of dietary calories]
Carbohydrates [maximum of 45% of dietary calories, complex carbohydrates]

Question 15

How is hepatic encephalopathy managed?

Answer 15

Correct precipitating factors [hypokalemia, GI hemorrhage, infection]
Restrict dietary protein [carefully, if needed; <12-16% of dietary calories]
Modify protein quality [vegetable or dairy proteins]
Adjunctive [lactulose, antibiotics, probiotics]

Question 16

How is ascites managed?

Answer 16

Dietary sodium restriction
Diuretics [furosemide, spironolactone]

Question 17

Define: Azotemia
Symptoms of Each Phase

Answer 17

Increase BUN, creatinine, or SDMA
Pre-Renal [Dehydration]: urine specific gravity high
Renal: urine specific gravity low, subclassified by urine output
Post-Renal: hyperkalemia, giant bladder if blocked, fluid in abdomen if ruptured

Question 18

Define: Anuria, Oliguria, Polyuria

Answer 18

Anuria: no urine output
Oliguria: decreased urine output
Polyuria: increased urine output

Question 19

What diagnostics should be done post-renal azotemia finding?

Answer 19

Urine culture [dilute urine can mask polyuria and bacteriuria]
Protein/creatinine ratio [if not inflamed or significant hematuria]
Abdominal radiographs [radiodense material, +/- ultrasound, contrast contraindicted]
Blood pressure

Question 20

What are the benefits of diets in the management of polyuric renal azotemia?

Answer 20

BUN control: highly digestible, low protein
Acidosis control: alkalinizing diets
Phosphorus control: secondary renal hyperparathyroidism
Corrects potassium wasting: extra supplementation sometimes indicates
Make sure they eat!

Question 21

Which urinary bladder stones are radiodense and can be dissolved by diets?

Answer 21

Calcium oxalate: dense
Struvite: dense
Silicate: dense
Urate: lucent (need ultrasound)
Cystine: lucent (need ultrasound)