Liver Disease

Question 1

causes of liver impairment

Answer 1

loss of glucose homeostasis, loss of protein synthesis, failure of bilirubin metabolism, loss of immune cells, loss of lipid homeostasis, altered drug metabolism

Question 2

causes of liver impairment

Answer 2

alcohol, non-alcoholic fatty liver disease, obesity, viral infection, autoimmune hepatitis, metabolic/cholestatic disorders, toxins

Question 3

stages of liver disease

Answer 3

chronic injury causes normal liver -> early fibrosis -> cirrhosis, leading to liver transplant or carcinoma

Question 4

non alcoholic and alcoholic liver disease

Answer 4

normal liver has fatty deposits, called fatty infiltration

can lead to stereohepatic, inflammation and fibrosis, eventually causing cirrhosis

Question 5

signs and symptoms of liver disease

Answer 5

loss of function or change in structure

fluid retention and portal hypertension

Question 6

later signs of liver impairment

Answer 6

pruritis (itch), jaundice, bleeding, bruising, enlarged breasts and shrunken testes in men, lack of periods, confusion, sensitivity to medication, trempling bonds, staggering

Question 7

liver function tests in obesity

Answer 7

testing for fibrosis and cirrhosis

Question 8

LFT: ALT

Answer 8

alanine aminotransferase

Question 9

LFT: AST

Answer 9

aspartate aminotransferase

also elevated in heart attacks

Question 10

LFT: GGT

Answer 10

gamma glutamyl transferase

liver specific

Question 11

LFT: bilirubin

Answer 11

breakdown of haem, excreted in bile

evevated in choleostasis and jaundice

Question 12

LFT: ALP

Answer 12

alkaline phosphotase

elevated in hepatic infection

Question 13

during impaired detoxifying

Answer 13

albumin levels reduced
ammonia levels rise
INR elevated

Question 14

treatment of impaired detoxification in liver

Answer 14

hep B & C can be treated
abstinance from alcohol
healthy diet
immunosuppression
transplant

Question 15

management of puritis

Answer 15

colestyramine, antihistamines, topical therapies, ondansetron, rifampicin, opioid antagonists

Question 16

managing encephalopathy

Answer 16

lactulose, laxatives

Question 17

managing ascites

Answer 17

salt restriction, diuretics, shunting

Question 18

managing oesophageal varicies (GI bleeding)

Answer 18

abx, endoscopy, non-selective beta blockers (ones that decrease bp in hepatic portal vein)

Question 19

managing acute alcohol withdrawal

Answer 19

admit to hospital if at risk of seizure, assess for withdrawal and treat with benzos if needed

Question 20

Wernicke’s encephalopathy

Answer 20

vit B1 deficiency, symptoms similar to intoxication

IV vitamins needed

Question 21

drug use in liver impairment

Answer 21

reduced metabolism of drugs, reduced plasma proteins so increased free drug levels, reduced first-pass metabolism so increased bioavailability