Hepatology Flashcards
What is the function of the liver?
- Makes Bile [Digests food]
- Metabolism of Drugs/Food/Toxins [activates prodrugs]
- Protien Synthesis [albumin and coag]
- Storage of vitamins
What are some of the Objective markers for Liver failure?
- Aspartate Transminase [AST]: 0-50 IU/L
- Alanine Transaminase [ALT]: 0-50 IU/L
- Alkaline Phosphatase [Alk Phos]: 30-120 IU/L
- Bilrubin: 0-1.4 mg/dL
- Albumin: 3.6-5.0g/dL
- INR: 0.9-1.1
- Thrombocyopenia: 150-450k
What is important to know about the Objective Markers in Liver Failure?
- AST, ALT, Alk phos = acute liver injury
- Decrease albumin, Increase INR, and/or Increase Bilirubin = Chronic Liver Disease
What is the estimated incidence of Drug-Induced Liver Injury?
- 14-19 cases per 100,000 people [0.014%]
- Have Jaundice
What are the classifications/mechanisms of liver injury/
- Direct [Acetaminophen]
- Idosyncratic [Beta-lactams, Fluoroquinolones, macrolides]
- Indirect [metabolic abnormalities causing non-alcoholic fatty liver disease]
What are the medications that are highest risk of causing Drug-Induced Liver Injury?
- ACETAMINOPHEN
- Anti-fectives [Isoniazid, Beta-Lactams, Fluoroquinolone, Macrolide]
What do you do with the medication if you suspect DILI?
- HOLD the agent
What is important to know about Acetaminophen DILI?
- High dose [>8g] causes toxic levels of N-Acetyl-p-benzoquinoe imine (NAPQI) = hepatotoxicity
- S/Sx: Abdominal pain, jaundice, N/V/D -^
- Can be reversed
What is the way that we reverse Acetaminophen DILI?
- N-Acetylcysteine [NAC] +/- activeted charcoal
What is the MOA for N-Acetylcysteine (NAC)?
- Binds to NAPQI, mimics Glutathione helping make NAPQI non-toxic metabolite [decreases hepatotoxic effects}
What way do we know how to use N-Acetylcysteine [NAC]?
- Conc. of Acetaminophen [>4hr after ingestion] and time of ingestion
- ORAL & IV
- USED RUMACK-MATTHEW NOMOGRAM
Describe how the Rumack-Matthew Nonogram is used?
- The “white” side = NO NAC; the “grey” side = NEED NAC
What is the definition of Cirrhosis?
- Severe, chronic, IRREVERSIBLE fibrosis of the liver
- INCREASED morbidity and mortality`
What are some of the causative factors for Cirrhosis?
- ALCOHOL [#1 in US]
- Viral Hepatitis
- Metabolic/Cholestatic Liver Disease
- Drug [Amiodarone, Methotraxate]
What are the two drugs that could cause Cirrhosis?
- Chronic use of Aminodarone or Methotrxate
What are the signs and symptoms of Cirrhosis?
- Fatigue, Weight Loss, Ascites, Jaundice, Hepatomegaly, Encephalopathy
What is the way that we assessing severity of Cirrhosis?
- Child-Pugh & Model for End-stage Liver Diease [MELD]
What is important to know about Child-Pugh score?
- Predicts mortality in Cirrhosis
- Class B: 7-9 = moderate severity
- Class C: 10-15 = severe severity
What is important to know about Model for End-stage Liver Disease?
- Predicts 3 month-mortality risk and used in transplant prioritization
- <9 = 1.9% risk to >40 = 71% risk
What is Ascites in liver disease?
- Fluid accumulation in the peritoneal space
- S/Sx: Distension, Pain, SOB, Nausea
What is the pathophysiology of Ascites?
Increased pressure within the portal hypertension that moves fluids into the peritoneal space
What is the way that we manage Ascites in liver disease?
- Non-pharm: restrict Sodium
- 1st line: Spiro & Furo
- 2nd line: Paracetesis
What is one class of drugs that should not be used in patients with Cirrhosis?
- NSAIDS - could increase fluid retention & vasodilatoin
What is important to know about the 1st line treatment of Ascites?
- Spiro 100 : Furo 40 once dialy
- COMBO is better than MONO [SPIRO is better than Furo]
What are some of the side effects and monitoring for Diuretics for Ascites?
- Spiro [Increased Potassium, Gynecomastia]
- Furo [Decreased Potassium]
- MONITOR: S/Sx of ascites, Scr, K+
What is Paracentesis?
- SECOND LINE for chronic; pulls fluids out of parental space
What happens when you remove >5L of fluids via Paracentesis?
- USED ALBUMIN [6-8g albumin per L]
- Decreases morbidity and mortality
