Hepatic Failure (NAFLD) Flashcards
T/F: LFTs are indicators of liver function.
- false
* indicators of hepatocellular injury
Which of the transaminases is liver specific?
- ALT
Total bilirubin can be measured in what 2 ways?
- (direct + indirect)
- (conjugated + unconjugated + delta)
What lab value is a good marker for chronic liver disease?
- albumin
Which of the coagulation pathway is a better predictor of liver disease?
- aPTT
INR can be elevated d/t malnutrition
All clotting factors except for ____ are made in the liver.
Factor VIII
NALFD has a strong association with these 2 factors.
- obesity
- insulin resistance
The pathophysiology of NALFD is based around what dysfunction?
- triglyceride disregulation
* precursors of TG are hepatotoxic
The fatty liver index (FLI) is composed of these 3 variables.
- triglycerides
- BMI
- waist circumference
What are the FLI cut offs and what risks correspond to each?
- <30 = low
- 30-60 = indeterminate
- > 60 = high*
*fatty liver ruled in
What are some signs of liver dysfunction/failure in later NAFLD? (3 listed)
- angiomas
- portal HTN
- jaundice
What is the first imaging modality you would get for NALFD?
- ultrasound
What is the gold standard diagnostic study for NALFD?
- liver biopsy
* see fibrosis developed
This new type of diagnostic study for NALFD uses ultrasound and low frequency waves.
transient elastography
What is NASH and what causes it?
- nonalcoholic hepatosteatosis
- result of progression of NALFD when tissue death and necrosis occurs (25% of patients)
To get a NAFLD Fibrosis score it requires these 4 variables.
- AST
- ALT
- platelet count
- albumin
What NALFD scores do we need to remember? What fibrosis stages do they correlate with?
- < -1.455 = F0-F2
- > 0.675 = F3-F4
What do the 4 fibrosis stages correspond with?
- F0 = no fibrosis
- F1 = mild
- F2 = moderate
- F3 = severe
- F4 = cirrhosis
What are the Fibrosis-4 (FIB-4) score criteria and what fibrosis stage do they correlate with?
- <1.54 = 0-1
- 1.54-3.25 = 2-3
- > 3.25 = 4
*fibrosis stage
Weight loss of ____ % can improve steatosis.
3-5%
*10% if steatohepatitis
What lifestyle modifications may help in the treatment of NAFLD? (5 listed)
- low carb diet
- weight loss
- exercise
- coffee
- vitamin E/C
Why is metformin not recommended for NAFLD?
- no histological improvement
What is one main side effect of pioglitazone?
- weight gain
What are the 3 drug therapies that have been used for treatment of NAFLD?
- metformin
- pioglitazone
- statins
*none first line
Large studies have shown this adverse side effect with bariatric surgery for NAFLD.
- increased fibrosis
When NAFLD has progressed to ELSD what is the only treatment option?
- liver transplant
What are the 2 markers of hepatic failure?
- Hepatic encephalopathy
- Elevated INR > 1.5
What is the typical toxin that causes hepatic encephalopathy?
- ammonia
T/F: Diagnosis of hepatic encephalopathy is clinical.
- True
How do you treat intercranial hypertension?
- mannitol/hypertonic saline
What is the most common cause of hepatic failure?
- acetaminophen (tylenol)
Tylenol overdose is reversible if treatment is started how soon?
- first 24 hours
* no damage if started <8 hours
At what part of tylenol metabolism does liver damage occur?
- damage occurs when glucuronide pathway is overwhelmed
* NAPBQI will accumulate = toxic*
What is the reversal agent for acetaminophen overdose and how does it work?
- N-acetylcysteine (NAC)
- works my replacing glutathione to break down NAPBQI
Activated charcoal can also be given with NAC for tylenol overdose if it is within how many hours of ingestion?
- < 2 hr from ingestion
What is the first sign of liver damage from tylenol overdose?
- elevated AST
What are the 4 potential causes of ischemic hepatitis?
- septic shock
- cardiogenic shock
- hepatic vein thrombosis
- cocaine
What does the MELD scoring provide?
What 2 values do we have to remember?
- prediction of 30 day mortality for ESLD
<8 - 5.7%
>20 - 50%
The MELD scoring system uses these 4 variables.
- bilirubin
- creatinine
- INR
- Na+
