Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Therapeutics IV Final Subjects > Liver Disease > Flashcards

Liver Disease Flashcards

1
Q

What are some different functions of the liver?

A 
Filtration of blood
secretion of bile
excretion of bilirubin
metabolic functions
conversion of sugar to glycogen
glycogen storage
protein and lipid synthesis
production of clotting factors
lipid and ammonia-urea cycle
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are some causes of liver disease?

A 
viral infections
drugs and toxins
biliary obstruction
inbonrn erros of metabolism
CV
Autoimmune
cryptogenic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the different types of liver disease?

A

Acute vs chronic
focal vs diffused
mild vs severe
reversible vs irreversible

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the most common causes of chronic liver siease and cirrhosis?

A

Alcohol and HCV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are two immediate life-threatening complications?

A

Acute variceal bleeding and spontaneous bacterial peritonitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

The liver recieves blood from the _______ artery and the ______ vein.

A

hepatic artery and the portal vein

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Where does the blood from the portal vein come from?

A

The mesenteric, gastric, splenic and pancreatic veins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the definition of cirrhosis?

A

chronic disease of the liver with widespread hepatic cell injury and hepatocyte destruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Inflammation in hepatocytes causes what?

A

permanent hepatic scarring and deposition of fibrous material

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Fibrosis ______ the normal blood flow through the liver

A

disrupts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

resistance to portal blood flow results in what?

A

persistent and progressive elevations in portal blood pressure or portal hypertension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are some sxs of cirrhosis?

A

pruritus, jaundice, hyperpigmentation

ascites, edema, malaise,anorexia, weight loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are some abnormal lab tests for cirrhosis?

A

hypoalbuminemia, elevated prothrombin time, thrombocytopenia, inc AP, inc LFTs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are Liver Function tests?

A

AST, ALT, AP, GGT, glotting factors (abnormal), bilirubin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How long can GGT be elevated?

A

for up to 3 wks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

At ESLD will you see abnormal LFTs?

A

No

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the Child-Pugh classification of Liver Disease?

A

A way to classify liver disease based on life expectancy and 1-yr survival

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is another liver disease classification system?

A

The Model for End Stage Liver Disease (MELD)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What lab values does the MELD score use?

A

bilirubin, INR, SCr

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is the Meld equation?

A

3.8xLn(bilirubin) + 11.2xLn(INR) + 9.6xLn(Scr) + 6.4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What does the MELd score tell you?

A

Risk of dying while waiting for a transplant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are some clinical manifestations ofl iver disease?

A 
portal hypertension
gastroesophagel varices and bleeding
acites
spontaneious bacterial peritonitis
hepatic encephalopathy
hepatorenal syndrome
coagulopathy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What causes portal hypertension?

A

inc portal pressure from:
1) structural resistnace to blood flow
2) intrahepatic vasoconstriction
Hepatic venous pressure gradient (normally 3-5) - its 10-12 in cirrhosis with varices

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

How do you diagnose gastroesophageal varices?

A

esophagogastroduodenoscopy (EGD)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What is given to prophylaxis of portal hypertension and variceal bleeding?
nonselective beta blockers (Propranolol 20mg BID or nadolol 20-40mg QD) or carvidolol
26
How is the dose escalated in propranolol or nadolol?
dec HR 20-25% or 55beats/min
27
How long do you need to use propranolol for prophylaxis of portal hypertension or variceal bleeding?
indefinitely unless not tolerated
28
What are some CI of propranolol?
``` Asthma/COPD Insulin-dependent diabetes - blocks side effects of diabetes peripheral vascular disease Heart block, bradycardia uncompensated CHF ```
29
What are some side effects of Propranolol?
Fatigue, SOb, lightheadedness
30
Do you prophylax on the formation of variceal polyps or just on them popping and bleeding?
on them popping and bleeding
31
AASLD guidelines recommend against prophylaxis use of:
Nitrate monotherapy nitrate + nonselective beta blockers carvedilol (not first line)
32
What are some risk factors of acute variceal bleeding?
Alcohol and NSAIDs
33
If the HVPG is greater than ___ you have difficulty controling bleeding, higher risk of early rebleeding and a higher 1yr mortality riate
>30mmHg
34
For an acute variceal bleed what should you give to prevent infection?
Prophylactive antibiotics for a max of 7 days: Norfloxacin Ciprofloxacin IV ceftriaxone
35
What is Octreotide used for?
acute variceal bleed iv bolus and then continuous infuction; continued for 3-5 days after diagnosis confirmed
36
what is Endoscopic varceal ligation?
Tie off nodules to slough them off
37
Should beta blockers be used in the acute variceal bleed?
No
38
What type of surgical options are there for portal hypertension and varceal bleeding?
transjugular intrahepatic portosystemic shunt, dec vascular resistance,
39
What is the TIPS procedure?
putting a connection between the portal vein and hepatic vein and using stent to open up a new vein formation to dec pressure
40
Ascites is a complication of _______
cirrhosis
41
What is ascites?
accumulation of fluid in peritoneal cavity
42
Portal hypertension leads to peripheral vasodilation which leads to _____________--
compensatory Na and water retention
43
How do you tx Ascites?
Underlying cause alcoholic hepatitis - abstinenece and time HBV cirrhosis - antiviral therapy Dietary salt restriction (2g/day) fluid restriction diuretics (spironolactone 100mg and Furosemid 40mg)
44
Consider holding diuretics if what?
Uncontrolled/recurrent hepatic encephalopathy | serum Na 2 mg/dL
45
Should liver transplantation be considered in patients with cirrhosis and ascites?
Yes
46
For Refractory ascites what are the tx options?
Paracentesis + albumin | TIPS procedure
47
What is SBP?
Spontaneous Bacterial Peritonitis | Infection of abdominal cavity due to ascites and portal hypertension
48
What are some sxs for SBP?
``` abdominal pain/tendernes fever/chills tachycardia hepatic encephalopathy altered WBC ```
49
How do you diagnose SBP?
positive ascitic fluid bacterial culture elevated ascitic fluid absolute PMN count abdominal paracentesis
50
What are the three most common isolates of SBP?
E.coli, K. pneumoniae, S. pneumonia
51
How do you tx SBP?
Cefotaxime 2gm IV q8h | Ceftriaxone 1gm Q24h
52
Could you consider Flouroquinolone in pts w/o prior quinolone exposure?
Yes
53
Should you give albumin infusions with antimicrobial therapy for SBP?
Yes
54
how do you prophylax SBP for pts with previous episodes?
Norfloxacin 400mg QD Trimethoprim-Sulfamethoxazole DS QD Ciprofloxacin 750mg PO qwk
55
What is Hepatic encephalopathy?
spectrum of neurological to psychosocial symptoms in the setting of liver disease - alterend level of consciouness, intellectual functioninong and behavior -altered skeletal muscle and motor skills Elevated ammonia level
56
What is the tx for HE?
``` avoid Benzos and narcotic analgesics (consider reversal with flumazenil/naloxone limit daily protein lactulose neomycin or metronidazole Rifaximin Zinc ```
57
How does lactulose work?
It is a nonabsorbable disaccharide that undergoes fermenation by gut flora and produces organic acids which lower colonic pH; the acidification of colon lowers ammonia levels in the blood by reducing protein degradation and ammonia absorption
58
What is the dose of Lactulose for management of HE?
20g/30mL PO TID, titrate to 3-4 bowel movements per day
59
Can you give Lactulose as an enema?
300mL mixed with 700mL water/saline
60
What are some adverse effects of Lactulose?
Diarrhea, Cramping, Flatulence, Dyspepsia
61
Can you use Neomycin or Metronidazole for HE?
Yes
62
What does neomycin do to bacteria?
kills them; inhibits activity of urease-producing bacteria
63
what is the Dose of neomycin for NE acute episodes and maintenance?
1g PO TID up to 6g daily for acute epidodes | 1-2 g PO daily for maintenance
64
when taking Neomycin what should you monitor for?
aminoglycoside so monitor renal function, ototoxicity and nephrotoxixicty with chronic use.
65
Can you use Neomycin with lactulose?
Yes
66
Can Metronidazole be used for HE? Why?
Yes; dec ammonia production by gut flora
67
What is the dose of metronidazole for HE?
250mg PO q6-12 hours
68
What must you be careful with when dosing metronidazole?
Neurotoxicity (peripheral neuropathy) with chronic use due to impaired hepatic clearance
69
Can Rifaximin be used for HE? What is the MoA for HE?
Yes; dec urease producing bacteria in the GI tract; <1% absorbed after oral administration
70
What is the prophylaxis dose of Rifaximin for HE?
550mg PO BID
71
What is the tx dose of Rifaximin for HE?
400mg PO TID
72
What is the efficacy of Rifaximin when compared to Neomycin?
Similar
73
What are some ADRs of Rifaximin?
HA, Abdominal pain, constipation, N/V
74
Can Zinc be used for HE?
Yes; cofactor of urea cycle enzyme
75
Can you send pts home on zinc and can it be used as monotherapy?
Yes, but no not monotherpay, must be on lactulose and an antibiotic
76
What is the dose of zinc for HE?
500mg daily can inc urea formation and lower ammonia levels
77
Can renal failure happen in pts with liver disease? How?
Yes, liver cirrhosis that leads to vasoconstriction in renal vasculature
78
What is the difference between type 1 and type 2 hepatorenal syndrome
Type 1 is rapidly progessive dec in renal function | Type 2 is steady moderate impairment in renal function
79
How do you manage hepatorenal syndrome?
``` avoid all nephrotoxic drugs avoid overaggressive diuretic use hemodialysis albumin infusions midodrine combined with octreotide expedited referral for liver transplantation ```
80
Impaired drug metabolism clinially significant only in severe liver disease with a Child-Pugh class of __
C
81
Which phase of metabolism is effected more by liver damage?
Phase 1 (oxidation)
82
Clearance of _____ extraction drugs is decreased in patients with chronic liver disease. So can you predict dosage reduction?
High; No you still cannot predict due to highly variable degree of hepatic blood flow reduction
83
There are three categories of drug extraction, what are they?
High (>60%) Intermediate (30-60) Low (<30%)
84
What are some high extraction drugs?
morphine, sertraline, fluvastatin, lovastatin, sumatriptan, labetalol, metoprolol, midazolam
85
Do we need a dosage reduction for renally eliminated drugs?
Yes
86
The volume of distribution of _______ drugs may be increased in patients with _____ and ______.
Hydrophilic ascites edema
87
If the drug causes the following things you have to consider dose adjusting in liver disease:
``` High extraction ratio drugs Inc Na and water retention Drugs that precipitate HE Drugs that inc risk of ADRs Highly protein bound drugs APAP ```

Therapeutics IV Final Subjects (10 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions