Liver disease Flashcards
Which lobe of the liver is bigger?
The right one
Does the liver have high tissue turnover?
Yeah
Is this class boring?
Yeah
Describe the blood supply to the liver.
Portal vein, hepatic artery.
Name some things that the liver synthesizes.
AAs, transaminases, urea, plasma proteins, lipoproteins, bile acids, cholesterol, phospholipids.
What does the liver store?
Glycogen, B12, fat soluble vitamins, and iron/ferritin
What is the progression of liver disease?
Inflammation –> fibrosis –> scarring –> cirrhosis
Is cirrhosis reversible?
Nope
Name a liver function test.
Blood transaminase levels (ALT, AST)
Name four causes of liver disease.
- Hep A
- Hep B
- Hep C
- Toxins
Which metabolite of alcohol is hepatotoxic?
Acetaldehyde
Which metabolic pathway of alcohol generates free radicals?
CYP450 MEOS
Make the Dx: Patient has history of alcohol abuse. Lab findings show AST : ALT is 2:1 and both are less than 300.
Alcoholic hepatitis
What comes before alcoholic hepatitis? What comes after?
Steatosis comes first, cirrhosis comes after
What is NASH and how is it often caused?
Non-alcoholic steatohepatitis is fatty infiltration + inflammation. Caused by metabolic disease and “second hit” - something else that causes inflammation.
What is NAFLD? How is it caused?
Non-alcoholic fatty liver disease. Caused by metabolic disease like diabetes. Constant gluconeogenesis results in constant FFA release –> fatty liver.
Can you damage your liver by overdosing on Tylenol?
Yeah
How do hemochromatosis and Wilson’s disease cause liver disease?
Excessive iron and copper are hepatotoxic.
What are varices and how are they caused?
Dilated veins in the esophagus, stomach, and rectum that are a complication of liver cirrhosis and increased portal hypertension. They can bleed.
What is portal gastropathy?
Varices in the stomach
How does liver disease cause ascites? What nutritional modifications should be made for patients with liver disease and ascites or edema?
Portal hypertension and low albumin levels. Must limit sodium and fluids; small frequent meals are also recommended.
How is hepatic encephalopathy caused? How is it treated?
When the liver is damaged it can’t clear the body of harmful metabolites like ammonia and it messes up your head. Treated with lactulose, which binds ammonia in the colon and causes diarrhea.
Why are patients with liver disease often malnourished?
Poor dietary intake, maldigestion, malabsorption, and abnormalities in metabolism and storage
What is the goal of nutrition management for patients with end stage liver disease?
To prevent or correct malnutrition and supply adequate calories without precipitating hepatic encephalopathy
On average, by what percentage is REE changed in patients with cirrhosis?
20-40% increase over normal REE
Is protein restriction indicated in patients with hepatic encephalopathy? What should be done?
No. It theoretically may lower ammonia levels but patients are often protein depleted so it may worsen body losses. Vitamin and mineral supplementation is done and BCAA intake is encouraged.
What are the manifestations of cirrhosis?
Jaundice, scleral icterus (yellow eyes), ascites
What is the ultimate treatment for end stage liver disease?
Transplantation
Are normal assessment methods chill for patients with end stage liver disease?
No, not really. Should use skinfold tests, grip strength, and nitrogen balance study. Ascites is a confounder of BMI.
