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LIVER DISEASE Flashcards

1
Q

What does DILD stand for?

A

Drug Induced Liver Disease

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2
Q

What does ALF stand for?

A

Acute Liver Failure

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3
Q

Halothane, antituberculous agents (isoniazid and rifampicin) psychotropics, antibiotics and cytotoxic drugs can cause …

A

Hepatotoxicity

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4
Q

Reye’s syndrome in children can lead to liver failure and is caused by taking what?

A

Aspirin

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5
Q

Isoniazid treatment involves monitoring LFT’s monthly for the first ____ months.

A

Three

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6
Q

NSAIDs do not normally pose a high risk of liver disease unless used in combination with other hepatotoxic drugs TRUE or FALSE

A

TRUE

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7
Q

Cholestatic lesions result in what?

A

Impaired bile flow (steroids)

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8
Q

Name some things associated with Steatosis…

A
  • Abnormal LFTs
  • Hyperammonia
  • Hypoglycaemia
  • Acidosis
  • Clotting factor deficiencies
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9
Q

At what level does clinical jaundice occur?

A

> 50mcmol/l

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10
Q

State some LFTs

A

Total bilirubin, alanine transaminase and alkaline phosphatase

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11
Q

How is impairment of synthetic function of liver detected?

A

Total protein, albumin and prothrombin time measurements

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12
Q

Low levels of albumin can lead to…

A

Oedema and decreased protein binding

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13
Q

Menadiol is ____ soluble and given at a dose of 10mg daily to treat coagulation disorders.

A

WATER soluble

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14
Q

What is palmar erythema?

A

Mottled reddening of the palms of hands

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15
Q

Child pugh score is used to assess mortality at what time period if the patient survives a haemorrhage

A

1 year

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16
Q

Child pugh score survival rates after 1 year
A - 100%
B - 80%
C - ?

A

45%

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17
Q

Treatment to control venous haemorrhage includes…

A

Terlipressin 2mg stat then 1mg 6 hourly

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18
Q

Ascites form due to activation of _____ as a consequence of hypovolaemia (decreased blood volume)

A

RAAS

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19
Q

Reduced _____ metabolism due to reduced liver function can contribute to increased fluid retention

A

Aldosterone (hyperaldosterone)

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20
Q

In the treatment of Ascites (accumulation of fluid within abdominal cavity) Salt should be restricted to a level of…

A

60-90mmol/day

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21
Q

What is the first line diuretic in the treatment of Ascites?

A

Spironolactone - aldosterone antagonist - blocks Na reabsorption in collecting tubules of kidney

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22
Q

Why can feminisation in males occur in those with liver disease?

A

Because the liver fails to metabolism oestrogen efficiently

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23
Q

Child pugh scores can be calculated to estimate severity of _____ of liver

A

Cirrhosis

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24
Q

Child pugh score takes into account…

A

AABIE: Albumin, Ascites, Bilirubin levels, INR and Encephalopathy

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25
AST and ALT released into blood of patients as consequence of _____ damage
hepatocyte
26
Which of the following is more liver specific? AST or ALT?
ALT. | AST if found in liver, heart, skeletal muscle, kidney and RBCs
27
NSIADs can cause GI _____ in those with liver disease
Ulceration
28
Which drugs can worsen encephalopathy? | Laxatives/ones that cause constipation
Those that cause constipation can cause/worsen encephalopathy
29
What should be used to treat Wernicke's encephalopathy?
Thiamine orally (IM/IV secondary care) plus vit B complex indefinitely
30
List some symptoms of Wenicke's encephalopathy...
Confusion, nausea, vomiting, fatigue, weakness or apathy
31
Hepatic encephalopathy grade 1 is associated with...
Confusion
32
Hepatic encephalopathy grade 4 is associated with...
Coma
33
Vitamin K1 tabs (phytomenadione) needs ____ to be absorbed as they are fat soluble. What is a consequence of this in somebody with malabsorption syndrome?
bile They'd need menadiol sodium phosphate tabs instead as these are water soluble.
34
A child pugh score of 6 puts you in what category?
A
35
A child pugh score of 10 puts you in what category?
C
36
A child pugh score of 7 puts you in what category?
B
37
When should Chlordiazepoxide be used?
- If alcohol withdrawal symptoms present
38
What test should be given to measure alcohol withdrawal symptoms?
- AWS - Alcohol withdrawal symptom score - States how much drug should be administered depending on score
39
How does lactulose 30-50ml tds adjusted to produce 2-3 soft stools daily, help with hepatic encephalopathy?
- Low MW organic acid - Reduces colonic pH - Kills ammonia producing bacteria - Reduces abs of ammonia
40
What is hepatic encephalopathy?
- Ammonia passes through diseased liver or bypass liver through shunts and go directly to brain - Increasing levels of ammonia in brain that lead to confusion (neuropsychiatric complications) - Ammonia inc perm of BBB to other neurotoxins so they can alter neurotransmission - Confusion, liver flap, coma
41
Why do patients with chronic liver disease often experience pruritus?
- Due to bile salt deposition in skin
42
What is the drug of choice when treating Pruritus in patients with Chronic Liver Disease? - How does this drug work? - How long can it take before benefits seen? - Potential side effects?
- Colestyramine - 4-8g daily in suitable liquid - Binds bile salts and reduces systemic bile salt levels - Can take up to a week to see improvement - GI side effects (constipation careful with enceph)
43
What advice should be given to those taking Colestyramine?
- Take other drugs at least 1 hour before or 4-6 hours after colestyramine to reduce possible interference with abs
44
What is first line drug treatment for ascites?
- Spironolactone - Aldosterone antagonist - Used alone or in combination with more potent loop diuretic
45
What non pharmacological methods for treatment of ascites are there?
- Restriction of salt intake in diet to 60-90mEq/day | - Fluid restriction 1-1.5L per day
46
Briefly outline the steps taken in treatment of ascites...
1) Salt (60-90mEq/day) and Fluid restriction (1-1.5L/day) 2) Spironolactone 3) Spironolactone and loop diuretic (furosemide) 4) Large volume paracentesis and colloid replacement
47
What painkillers should be avoided in those with chronic liver disease?
- NSAIDs due to bleed risk and CV risk | - Opioids due to encephalopathy risk (constipation)
48
What analgesics can cause fluid retention in ascites?
- NSAIDs | - Corticosteroids
49
What is Cholestasis?
- Injury to bile ducts (can be caused by drugs) - Partial or complete obstruction to bile duct - Retention of bile acids - Raised bilirubin
50
When might fresh frozen plasma or clotting factor concentrates be needed?
- If bleeding occurs due to a coagulation disorder
51
What is one of the main causes of spider naevi?
- Higher oestrogen levels
52
What can lead to oedema and ascites in liver disease?
- Activation of the RAAS (causes fluid and salt retention) - Low levels of albumin cause fluid retention - Less metabolism of aldosterone
53
Portal hypertension due to liver disease can result in what?
- Oesophageal varices - Ascites - Caput Medusae (enlarged veins on stomach due to portal systemic shunting)
54
List some general symptoms of liver disease...
- Liver flap - Palmar erythema - Ascites - Spider naevi - Jaundice - Yellowing of sclera - Whitening of nails and highly polished nails - Confusion, low concious associated with encephalopathy - Caput medusae (enlarged umbilical veins) - Gynaecomastia - Tender, painful abdomen (spont bac peritonitis?) - Scratch marks (scratching of skin) - bile salts
55
If one is presenting with derangement of liver function, what should be tested for? What other technique can be used to see, size, shape and texture of the liver?
- Hepatitis A, B and C | - Ultrasound
56
Antihistamines are usually second line treatment in the treatment of pruritus in liver disease. Are sedating or non sedating preferred and why? Suggest one to use.
- Non-sedating are preferred as sedating may mask the signs and symptoms of encephalopathy - E.g Cetirizine or loratidine
57
When might liver transplant be an only option in relation to vitamin K?
- If the patient has a raised INR and IV phytomenadione (10mg daily for 3 days) is not improving the INR then we know that significant liver disease is present - This means the patients liver may not be able to utilise the vitamin to synthesis clotting factors
58
Patients with ascites should be closely observed for WHAT? - If this is suspected what should happen? - What result is diagnostic of the condition?
- Spontaneous bacteria peritonitis - Diagnostic ascitic tap - Leucocyte count of greater than 250 cells/mm3
59
If a test for spontaneous bacterial peritonitis comes back positive then what should happen?
- Started on antibiotic therapy | - Cefotaxime 2g 8 hourly
60
Oesophageal varices should be treated with/by what?
- Initially fluid replacement (colloid or packed red cells) - Terlipressin (infusion for 2-5 days) - Banding/sclerotherapy (vatical band ligation) - Balloon tamponade
61
What are the drugs of choice in prevention of rebelling and used as primary prophylaxis against variceal bleeding?
- Non-selective B-blockers e.g propranolol

DONE CLINICAL (10 decks)

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