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Clin 2 > Liver Disease > Flashcards

Liver Disease Flashcards

1
Q

What are the 2 sources that the liver receives blood from?

A

hepatic artery & hepatic portal vein

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2
Q

Name some of the liver functions.

A
  • carb metabolism
  • lipid metabolism
  • protein metabolism
  • enzyme metabolism
  • vitamin metabolism
  • bile acid metabolism
  • heme metabolism
  • storage
  • detoxification, degradation, conjugation
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3
Q

What are the common disease/conditions of liver?

A
  • hepatitis (A-E)
  • alcoholic hepatitis and cirrhosis
  • NAFLD
  • NASH
  • fibrosis
  • cirrhosis
  • liver failure
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4
Q

Which type of bilirubin is more toxic?

A

unconjugated

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5
Q

What is prothrombin time (PT)?

A

the number of seconds for blood clot (it is prolonged in liver disease)

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6
Q

What are some clinical manifestations of liver disease?

A
  • hepatomegaly
  • ascites
  • jaundice
  • esophageal varices
  • spider angiomas
  • encephalitis and coma
  • hepatorenal syndrome
  • coagulopathies
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7
Q

What can jaundice be caused by? (3-4 things)

A
  • excessive bilirubin production due to hemolysis
  • acute or chornic hepotocellular injury
  • obstruction of bile ducts
  • newborn jaundice
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8
Q

What can icteric sclera be caused by (4)?

A
  • hypoalbuminemia (less bilirubin bound)
  • response to TPN (less binding of bilirubin)
  • liver diseases
  • trauma (excess and possible liver dysfunction)
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9
Q

What are 5 complications of ascites?

A
  • respiratory distress syndrome
  • sepsis
  • dilutional hyponatremia
  • renal dysfunction
  • umbilical hernias
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10
Q

What are the 3 possible treatments for ascites?

A
  • sodium/fluid restriction
  • use of diuretics
  • paracentesis (withdrawal of fluid from the abdomen via a catheter)
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11
Q

What is the treatment for HE?

A
  • lactulose
  • antibiotics
  • Pro 1.2-1.5 g/kg/d
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12
Q

What is the MELD?

A

used to predict mortality rate after TIPS
calculate a patient’s likelihood of dying within three months
high score = severe liver disease
3 blood tests:
- bilirubin
- PT
- creatinine

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13
Q

Describe the 4 types of hepatitis.

A

A:
transmitted almost only through oral-fecal route

B:
Transmitted via blood-derived fluids, improperly sterilized medical instruments

C:
exposure to blood or body fluids from an infected person

D&E:
very uncommon - acute infection

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14
Q

What is acute liver failure characterized by (3)?

A

hepatic necrosis, coagulopathy, encephalopathy

treatment: liver transplant

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15
Q

What are the nutritional implications of having hepatitis?

A
  • nausea and vomiting, abdominal pain
  • anorexia with weight loss
  • hypoglycemia (decreased gluconeogenesis)
  • fluid and electrolyte imbalances
  • prolonged PT
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16
Q

What are the nutrition interventions for hepatitis?

A

30-35kcal/kg
1-1.2g/kg pro

high energy and high protein diet

17
Q

What is NAFLD?

A

refers to a wide spectrum of liver disease ranging from steatosis to nonalcoholic steatohepatitis (NASH) and to cirrhosis

more common in men

18
Q

What are the nutrition interventions for NAFLD?

A
  • intensive lifestyle intervention leading to weight loss
  • abstinence from alcohol
  • use of vitamin E
  • adopt mediterranean diet
19
Q

What is the hepatotoxic alcohol threshold?

A

40g for men -> 4 drinks

20g for women -> 2 drinks

20
Q

What are the 3 liver disorders associated with ALD?

A
  • fatty liver (hepatic steatosis)
  • alcoholic hepatitis
  • cirrhosis
21
Q

What are the clinical presentations of ALD? (nonspecific and specific symptoms)

A 
fatigue
weakness
nausea
anorexia
fever
jaundice
hepatomegaly
ascites
portal hypertensive bleeding
hepatic encephalopathy
22
Q

What are the minor alcohol withdrawal symptoms and complications?

A 
insomnia
tremulousness
mild anxiety
gastrointestinal upset
anorexia
headache
diaphoresis

withdrawal seizures
alcoholic hallucinosis
delirium tremens
micronutrient deficiencies

23
Q

What are the vitamin and mineral deficiencies in ALD?

A

B vitamins
selenium
zinc
magnesium

24
Q

What are the nutrition interventions for ALD?

A
  • correct malnutrition
  • correct nutritional deficiencies
  • restriction of sodium, fluid and others
  • ensure adequate energy and protein intake without increasing the risk of HE
25
Q

What are the 5 main causes of cirrhosis?

A
  • hepatitis
  • alcoholic liver disease
  • hepatitis C + alcoholic liver disease
  • cryptogenic causes
    hepatitis B
26
Q

What are the clinical manifestations of cirrhosis? (nonspecific and specific symptoms)

A 
fatigue
weakness
nausea
poor appetite
malaise
vit and mineral deficiencies
jaundice
dark urine
light stools
steatorrhea
itching
abdominal pain
bloating
27
Q

What are the major clinical complications of cirrhosis?

A
  • portal hypertension
  • hepatic encephalopathy
  • ascites
  • hepatorenal syndrome
  • esophgeal varices
28
Q

What is the compensated and decompensated state of cirrhosis?

A

Compensated: cirrhosis without ascites or encephalopathy

Decompensated: cirrhosis with ascites or encephalopathy

29
Q

What are the nutritional implications of having cirrhosis?

A
  • increased energy expenditure related to acute complications
  • malnutrition
  • sarcopenia
  • micronutrient deficiencies
  • early satiety from ascites
  • hypoglycemia
30
Q

What are the nutrition interventions for cirrhosis?

A

30-35kcal/kg
1.2-1.5g/kg

For OBESE patients:
25kcal/kg IBW
2.0-2.5g/kg IBW

  • Replace vitamins and minerals
  • Sodium restriction in ascites
  • Soft diet for patients with esophageal varices
  • Lifestyle interventions
31
Q

What do furosemide and spironolactone do?

A

Furosemide:
increase excretion of Na, K, Mg, Ca
Diet high in K, Mg, Ca

Spironolactone:
increase reabsorption of K
avoid salt substitutes, avoid excess K in diet

32
Q

What are the interventions for liver transplant?

A
  • oral or EN preferred
  • patients should be managed according to ERAS
  • 30-35kcal/kg
    1. 2-1.5g/kg

for OBESE patients:
25kcal/kg IBW
2.0-2.5g/kg IBW

Clin 2 (11 decks)

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