Internal Medicine: Gastroenterology: Liver Disease Treatment Flashcards
What are the general principles of treatment of liver disease?
- Eliminate causative agent
- Suppress ongoing disease
- Optimise regenerative capacity
- Control complications
How can therapy of liver disease be tailored to the clinical picture?
- Dietary modification
- Ursodeoxycholic acid- UDCA
- Anti-oxidant drugs and glutathione donors
- Treatment of complications
How can therapy of liver disease be tailored to biopsy results?
- Inflammatory cells- neutrophils/lymphocytes
- Fibrosis
- Copper accumulation
- Positive bacterial culture
Appropriate ABs, immunosupression, anti-fibrotic drugs, decoppering drugs
How can dietary managment be used for the following:
1. Hepatic encephalopathy
2. Chronic active inflammation
- Minimise ammonia production
* 2. protein restriction
* high biological value protein - Reduce inflammation, prevent copper accumulation
* Alter mineral balance- low Cu, High Zn
* Fat-soluble vitamins- ADEK
* Taurine and L-carnitine for cats
* Add cottage cheese to standard hepatic diet
What antibacterial therapy is indicated for:
- Hepatic encephalopathy
- Bacterial cholangiohepatitis
Hepatic enceph
* Use empirically
* Ampicillin or metronidazole
Bacterial cholangiohep
* Documented infection
* Need culture and sensitivity
What are the advantages and disadvantages of glucocorticoids?
Adv
* Improved well-being
* Appetite stimulation
* Anti-inflam
* Immunosuppression
* Anti-fibrotic
Dis
* Steroid hepatopathy
* Predispose to infection
* Fluid retention
* Catabolic
What are the indications for glucocorticoid therapy?
- Chronic active inflammation- lymphocytes and plasma cells on biopsy
- Hepatic fibrosis
What breeds are affected by copper associated hepatopathies?
- Bedlington terrier
- WHWT
- Skye terrier
- Dalmation
- Labrador
- Doberman
What are used for ‘decoppering agents’
Copper chelators
* D-penicillamine
* 222-tetramine
Copper absorption blocker
* oral zinc- 1 hour before feeding
What adjunctive therapy can be given for liver disease?
- Ursodeoxychloic acid
- S-Adenosyl methionine
- Milk thistle
- Vitamin E
What is the function of ursodeoxycholic acid?
Hydrophilic ‘beneficial’ bile salt
* Alters bile composition- decreases hydrophobic bile acids
* Stimulates bile flow- contraindicated if complete obsruction
* Modulated inflammatory/immune response
What is the function of S-Adenosyl methionine?
Glutathione donor- precursor
Central to:
* Hepatic metabolism
* Detoxification
What are the active agents of milk thistle?
What are the actions?
Active agents- silly milk thistle
* Silychristine
* Silydianin
* Silybin
Actions
* Free radical scavenger
* Inhibits inflammation
* Inhibits lipid peroxidase
* Inhibits collagen deposition
* Increase glutathionine
What are the indications for:
1. UCDA
2. SAMe
3. Milk thistle
- Biliary tract, gall stones
- Paracetamol, hepatobiliary toxicities
- Hepatobiliary
What are complications of liver disease?
- Hepatic encephalopathy and coma
- Ascited and oedema
- Haemorrhage and anaemia
