Liver disease – treatment Flashcards
What are the 4 principles of treatment for liver disease?
- Eliminate causative agent
- Suppress ongoing disease
- Optimise regenerative capacity
- Control complications
How can therapy for liver disease be tailored to the clinical picture?
- Dietary modification
- Ursodeoxycholic acid (UDCA)
- Anti-oxidant drugs & glutathione donors
- Treatment of complications
How can therapy for liver disease be tailored to biopsy results?
Inflammatory cells = antibiotics, immunosuppressive
Fibrosis = anti-fibrotic drugs
Copper accumulation = decoppering drugs
Positive bacterial culture = appropriate antibiotic
Describe how you would use dietary management to treat hepatic encephalopathy
Aim = Minimise Ammonia production
Protein restriction ± modification
Restrict if shunt present
High biological value
- Dairy
- Vegetable
Describe how you would use dietary management to treat chronic active inflammation
Aims:
-> Reduce inflammation
- >Prevent copper accumulation
- Alter mineral balance: Low copper and high zinc
- Fat-soluble vitamins: A,D,E,K
- Taurine & L-carnitine for cats
- Protein restriction rarely required
Would you use antibacterial therapy for hepatic encephalopathy?
Use empirically based on clinical picture
Ampicillin or metronidazole
Would you use antibacterial therapy for bacterial cholangiohepatitis
Documented (proven bacterial) infection e.g. cholangiohepatitis
Need culture and sensitivity (bile and tissue)
What would be seen on the biopsy of chronic active inflammation to indicate glucocorticoid therapy?
Lymphocytes and plasma cells
What would be seen on the biopsy of hepatic fibrosis to indicate glucocorticoid therapy?
Fibrosis/cirrhosis
What are the advantages of glucocorticoid therapy in liver disease cases?
Improved well-being
Appetite stimulation
Anti-inflammatory
Immunosuppression
Anti-fibrotic
What are the disadvantages of glucocorticoid therapy in liver disease cases?
Steroid hepatopathy
Predispose to infection
Fluid retention
Catabolic
List the breeds affected by copper associated hepatopathies. Why are these breeds affcted?
Bedlington terrier
WHWT
Skye terrier
Dalmatian
Labrador
Doberman
- Can’t excrete copper as they normally should leading to a massive levels accumulating in the liver
Same some decoppering agents
Copper chelators
- D-penicillamine
- 2,2,2-tetramine
Copper absorption blockers
- Oral zinc
Reducing copper in the diet
What are the pros of adjunctive therapy?
Can be tailored to the clinical picture
Do not need biopsy results
Broad spectrum of activity
Wide safety margin
Combination therapy used
List 4 adjunctive therapies used with liver disease
Ursodeoxycholic acid (UDCA)
S-Adenosyl methionine (SAMe)
Milk thistle
Vitamin E
Describe how Ursodeoxycholic acid works as an adjunctive therapy
Hydrophilic (water soluble), ‘beneficial’ bile salt
- Alters bile composition: Decreases hydrophobic bile acids
- Stimulates bile flow: Contraindicated if complete biliary obstruction
- Modulates inflammatory/immune response
Describe how S-Adenosyl methionine works as an adjunctive therapy
Glutathione (GSH) donor E.g. a precursor for GSH production
GSH = endogenous molecule central to: Hepatic metabolism and Detoxification
Silymarin is another name for?
Milk thistle
What are the actions of milk thistle?
Free-radical scavenger
Inhibits inflammation
Inhibit lipid peroxidase
Inhibit collagen deposition
Increase glutathionine
What are the advantages of milk thistle?
Wide safety margin
No absolute contraindications
Broad spectrum of activity
What are the disadvantages of milk thistle?
Cost
Evidence for efficacy?
Does not reduce mortality
Does not improve histology picture
Does not improve biochemical markers
Protein restriction is used to dietary manage which condition?
Hepatic encephalopathy
Describe the diet used for liver disease due to chronic active inflammation
Low Copper
High zinc
High protein quality
Anti-oxidants
What are the main complications of liver disease
Hepatic encephalopathy & coma
Ascites and oedema
Haemorrhage and anaemia
