Liver Disease

Question 1

Main categories of liver disease and associated causes and changes

Answer 1

Acute- onset <6/12. Viral or drug cause
Chronic- onset >6/12. Alcohol or biliary atresia cause

Fatty liver
Cholestasis
Compensated cirrhosis
Decompensated cirrhosis
Acute liver failure

Question 2

Measures of liver functions

Answer 2

LFT’s:
ALT - cell death. Hepatocellular damage
AST - cell death. hepatocellular damage, acute MI. low= vit B6 deficiency or pregnant.
ALP - biliary problems. cholestasis, children, bone disease. low= vit D toxicity, scurvy.
yGT- biliary problems. high= cholestasis, diabetes, alcohol abuse, enzyme inducing medications.
Bilirubin. high= jaundice, haemolysis.
Clotting- synthesis. high= clotting disorder, anticoagulants, low vit K.
Albumin- synthesis. low= infection, Crohn’s, malnutrition. high= ascites, oedema.

De Ritis Ratio= AST:ALT >1 = alcohol related, <1 = non-alcoholic

Question 3

Understand the link between common categories of liver disease, test results and other info

Answer 3

Twice upper limit of normal.

Question 4

Understand how changes in liver function impact PK and drug choice

Answer 4

ADME

Question 5

Know what drugs should be avoided or used w/ caution in liver disease and why

Answer 5

Avoid statins, amoxicillin, antibioitcs, NSAIDs, phenytoin, block cohosh.