LIVER 1 Flashcards
What are the consequences of fibrosed/ diseased/ inflammation
- impedes blood flow
- Gastroreflux
-peptic ulcer - oeseophageal varices
What is the function of the liver
- produce bilesalts for emulsification of fat soluble vitamins
- Metabolism of drugs and nutrients
- filtering microbes etc
- gluconeogenesis
- bilirubin breakdown
- Exocrine function: bilirubin, bile salts, cholesterol
- synthesis: clotting factors/ antibodies
How does the liver handle drugs?
Transports drugs via plasma proteins
site for metabolising drugs
liver excretes some drugs
activates/ deactivates drugw
What is the solubility of drugs?
most drugs insoluble in water, solbule in fats
What are the phases of drug metabolism
Phase 1: . make molecules more polar
- hydrolysis
- reduction
- hydroxylation
- oxidation
phase 2: makes molecules less active, more water soluble
- conjugate with
What is the effect of first pass metabolism?
Can affect peak concentration & activity of drugs
- therefore affects the drug administration route
What affects drug metabolism?
-Age
-Gender
-Genetics
-Diet and gut flora
-Pathological conditions which reduce enzyme activity→ liver disease, kidney disease, reduced hepatic blood flow in heart failure/ shock
-Enzyme induction/ enzyme inhibition
What does the liver synthesis (endocrine function)
Clotting factors
Albumin
Antibodies
What does the liver metabolise
Drugs: first pass metabolism
Bilirubin cycle
Hormones→ not functioning well can affect hormone activity
Energy gluconeogenesis
What are the signs and symptoms of liver disease
jaundice (increase bilirubin)
- finger clubbing
- gynaecomastia
-SIALOSIS: Bilateral swelling- diabetes, alchoholism
- bleed a lot
Causes of liver disease:
Alcohol
Drugs→ paracetamol
Infections→ viral hepatitis
Chronic:
Cirrhosis (scarring)
Infections
Alcohol
How does alcohol cause liver disease/
Ethanol metabolism: Ethanol→ acetaldehyde→ Acetate
Highly reactive
Toxic
Causes inflammation & death of hepatocytes
How does paracetamol cause liver disease?
95% of paracetamol is metabolised into sulphate & glucoronide
5% metablised into N-acetyl-p-benzoquinone imine (highly reactive & toxic)
exceeding the dose saturates phase 2 metabolism
- causes death of hepatocytes & inflammation
What is hepatitis and its causes
Inflammation of the liver:
Infections
Viral→ A,B,C,E
Malaria
Alcohol
Drugs
Toxins
What is the route of transmission, consequences and recovery of Hep A
route of transmission: faecal-oral route
risk factors: poor oral hygiene
vaccine avaliable
long term impact: recover <2 months
What is the route of transmission, consequences and recovery of Hep B
Route of transmission: sexual contact, mother to newborn
risk factor: working in hospital, IVDA, sex workers,
diagnosis: HbSag (surface indicates 1-4 months post infection)
HbcAg: infective
consequence: hepatitis
What is the route of transmission, consequences and recovery of Hep C
Route: infected blood, mother to new born
risk factor: blood, IVDA, HIV
Long term: cirrhosis, hepatitis
What is the route of transmission, consequences and recovery of Hep E
route: faecal-oral
risk factors: poor hygiene, travelling broad to endemic areas
long temr: recover in 2 months
no vaccine
What drugs are cytochrome inducers & what is the effect of these drugs
Cytochrome inducers: Reduce the concentration of drug- makes warfarin more THROMBOTIC
-CRAP GPs
carbmazepine
Rifampicin
Alcohol (chronic use)
Phenytoin
Griseofulvin
Phenobarbitone
Sulphonylureas
What drugs are cyctochrome p450 inhibitors and what is the effect
Increase the concentration of drug metabolism, higher concentration of these- pt bleeds more
SICKFACES.COM
- Sodium valporate
–isoniazid
-cimetidine
- ketconazole
- fluconazole
- alcohol and grapefruit juice
- Chloramphenicol
-Erythromycin
- Ciproflaxcin
-Omeprazole
- Metronidazole
