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DONE CLINICAL > LIVER DISEASE > Flashcards

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
Q

AST and ALT released into blood of patients as consequence of _____ damage

A

hepatocyte

26
Q

Which of the following is more liver specific?

AST or ALT?

A

ALT.

AST if found in liver, heart, skeletal muscle, kidney and RBCs

27
Q

NSIADs can cause GI _____ in those with liver disease

A

Ulceration

28
Q

Which drugs can worsen encephalopathy?

Laxatives/ones that cause constipation

A

Those that cause constipation can cause/worsen encephalopathy

29
Q

What should be used to treat Wernicke’s encephalopathy?

A

Thiamine orally (IM/IV secondary care) plus vit B complex indefinitely

30
Q

List some symptoms of Wenicke’s encephalopathy…

A

Confusion, nausea, vomiting, fatigue, weakness or apathy

31
Q

Hepatic encephalopathy grade 1 is associated with…

A

Confusion

32
Q

Hepatic encephalopathy grade 4 is associated with…

A

Coma

33
Q

Vitamin K1 tabs (phytomenadione) needs ____ to be absorbed as they are fat soluble.

What is a consequence of this in somebody with malabsorption syndrome?

A

bile

They’d need menadiol sodium phosphate tabs instead as these are water soluble.

34
Q

A child pugh score of 6 puts you in what category?

A

A

35
Q

A child pugh score of 10 puts you in what category?

A

C

36
Q

A child pugh score of 7 puts you in what category?

A

B

37
Q

When should Chlordiazepoxide be used?

A
  • If alcohol withdrawal symptoms present
38
Q

What test should be given to measure alcohol withdrawal symptoms?

A
  • AWS
  • Alcohol withdrawal symptom score
  • States how much drug should be administered depending on score
39
Q

How does lactulose 30-50ml tds adjusted to produce 2-3 soft stools daily, help with hepatic encephalopathy?

A
  • Low MW organic acid
  • Reduces colonic pH
  • Kills ammonia producing bacteria
  • Reduces abs of ammonia
40
Q

What is hepatic encephalopathy?

A
  • 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
Q

Why do patients with chronic liver disease often experience pruritus?

A
  • Due to bile salt deposition in skin
42
Q

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?
A
  • 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
Q

What advice should be given to those taking Colestyramine?

A
  • Take other drugs at least 1 hour before or 4-6 hours after colestyramine to reduce possible interference with abs
44
Q

What is first line drug treatment for ascites?

A
  • Spironolactone
  • Aldosterone antagonist
  • Used alone or in combination with more potent loop diuretic
45
Q

What non pharmacological methods for treatment of ascites are there?

A
  • Restriction of salt intake in diet to 60-90mEq/day

- Fluid restriction 1-1.5L per day

46
Q

Briefly outline the steps taken in treatment of ascites…

A

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
Q

What painkillers should be avoided in those with chronic liver disease?

A
  • NSAIDs due to bleed risk and CV risk

- Opioids due to encephalopathy risk (constipation)

48
Q

What analgesics can cause fluid retention in ascites?

A
  • NSAIDs

- Corticosteroids

49
Q

What is Cholestasis?

A
  • Injury to bile ducts (can be caused by drugs)
  • Partial or complete obstruction to bile duct
  • Retention of bile acids
  • Raised bilirubin
50
Q

When might fresh frozen plasma or clotting factor concentrates be needed?

A
  • If bleeding occurs due to a coagulation disorder
51
Q

What is one of the main causes of spider naevi?

A
  • Higher oestrogen levels
52
Q

What can lead to oedema and ascites in liver disease?

A
  • Activation of the RAAS (causes fluid and salt retention)
  • Low levels of albumin cause fluid retention
  • Less metabolism of aldosterone
53
Q

Portal hypertension due to liver disease can result in what?

A
  • Oesophageal varices
  • Ascites
  • Caput Medusae (enlarged veins on stomach due to portal systemic shunting)
54
Q

List some general symptoms of liver disease…

A
  • 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
Q

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?

A
  • Hepatitis A, B and C

- Ultrasound

56
Q

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.

A
  • Non-sedating are preferred as sedating may mask the signs and symptoms of encephalopathy
  • E.g Cetirizine or loratidine
57
Q

When might liver transplant be an only option in relation to vitamin K?

A
  • 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
Q

Patients with ascites should be closely observed for WHAT?

  • If this is suspected what should happen?
  • What result is diagnostic of the condition?
A
  • Spontaneous bacteria peritonitis
  • Diagnostic ascitic tap
  • Leucocyte count of greater than 250 cells/mm3
59
Q

If a test for spontaneous bacterial peritonitis comes back positive then what should happen?

A
  • Started on antibiotic therapy

- Cefotaxime 2g 8 hourly

60
Q

Oesophageal varices should be treated with/by what?

A
  • Initially fluid replacement (colloid or packed red cells)
  • Terlipressin (infusion for 2-5 days)
  • Banding/sclerotherapy (vatical band ligation)
  • Balloon tamponade
61
Q

What are the drugs of choice in prevention of rebelling and used as primary prophylaxis against variceal bleeding?

A
  • Non-selective B-blockers e.g propranolol

DONE CLINICAL (10 decks)

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