Liver Disease Flashcards
what does hepatitis mean
inflammation
what does steatosis mean
fatty
steatohepatitis means
fatty inflamed liver
What can cause liver disease?
alcohol excess viruses - hep B & C obesity autoimmune hepatitis drugs haematomachrosis - XS iron wilsons disease - XS copper cystic fibrosis
List complications of liver disease
- jaundice (usually bilirubin > 35) can cause pruritis
- hypoalbuminaemia
- portal hypertension leading to varies and possible vatical bleed
- ascites
- clotting abnormality
- hepatic encephalopathy
- splenomegaly (as a result of portal hypertension. Can cause thrombocytopenia)
How does Child-pugh score?
score <6 = grade A
score 7-9 = grade B
Score > 10 = grade C
How is jaundice treated?
It is usually only treated for patients who get pruritus. Antihistamines are usually ineffective and can have sedating effect which isn’t good when were looking out if a patient has hepatic encephalopathy.
Cholestyramine binds to bile acids to precent their reabsorption however it also binds to fat soluble drugs which can effect their medicine regime.
Patient will colestatic liver disease e.g. primary biliary cirrhosis may be treated with ursodeoxycholic acid (10-15mg/kg in two divided doses) or rifampicin 300mg BD (unlicensed)
How is clotting abnormalities treated?
vitamin K however patients with severe dysfunction may be unable to use vit K to produce closing factors
How is portal hypertension treated?
propanolol 20-40mg daily initially. Restricted by low BP and it also undergoes first pass metabolism which would be reduced in these sorts of patients.
Varicies - terlipressin 2mg IV every four hours then every 72 hours
How to treat hepatic encephalopathy
lactulose to produce 2-3 soft stools a day. Consultation can be an aggravating factor and lactulose is broken down by the gut bacteria to lactic acid, bacterial conversion of protein to ammonia is reduced.
ABX are sometimes used to reduce the bacteria load in the gut. Neomycin was originally used but has a risk of ototoxicity. Rifampicin can be used but is expensive.
How to treat ascites
- sodium restrict to 90mmol/day
- spironolactone 100-400mg.
- aim to lose 0.5-1kg/day. Doses should be reduced if patients are losing more than 1 kg a day
- furosemide in recurrent ascites
- pt aren’t usually fluid restricted unless they have hyponatraemia
SBP means?
treatment?
Spontaneous bacterial peritonitis?
ABX to cover gram-ova including E.coli.
Patients would then start on human albumin solution (1.5mg/kg on day 1 followed by 1g/kg on day 3) - This is to kept reduce the risk of renal impairment which happens in 30% of patients.
Following treatment of SBP. Prophylactic ABX such as ciprofloxacin 500mg/day are used.
What sort of drugs should we be wary of in patients with liver disease?
hepatically cleared drugs - clearance may be reduced however its hard to know how to reduce these drugs as its not as straight forward like renal meds.
Sedating drugs - encephalopathy
constipating drugs - encephalopathy
NSAID - can cause gastric ulceration - any bleeding from ulcers is likely to be worse in patients with chronic liver disease. They can also cause fluid retention (which can worsen in ascites) and renal impairment.1
Which drug can cause gynaecomastia and hyperkalaemia
spironolactone
which drug can cause constipation
cholestyramine
