Liver Disorders Flashcards
What is cholestasis?
Impaired bile formation or flow
Symptoms of cholestasis
Fatigue, pruritus, dark urine, pale stools, jaundice, signs of fat-soluble vitamin deficiencies
Treatment of cholestatic pruritus
Cholestyramine
Ursodeoxycholic acid
Rifampicin (unlicensed)
Sertraline (unlicensed)
Naltrexone (unlicensed)
How does cholestyramine relieve pruritus?
By forming an insoluble complex in the intestine with bile acids and other compounds—the reduction of serum bile acid levels reduces excess deposition in the dermal tissue with a resultant decrease in pruritus
Cautions of rifampicin
Patients with pre-existing liver disease
Treatment of intrahepatic cholestasis in pregnancy
Ursodeoxycholic acid
When is it most common to have intrahepatic cholestasis in pregnancy?
During late pregnancy and associated with adverse fetal outcomes
What are gallstones?
Hard mineral or fatty deposits forming stones in the gallbladder bile duct
Risk factors of gallstones
Crohn’s disease.
Diabetes mellitus.
Diets higher in triglycerides and refined carbohydrates and low in fibre are associated with gallstones.
Females
Non-alcoholic fatty liver disease
Symptoms of gallstones
Majority of patients will be asymptomatic
If gallbladder is blocked or irritated = pain, infection, inflammation
Complications of gallstones
Biliary colic, cholecystitis, cholangitis, pancreatitis, obstructive jaundice
Advice to patients with gallstones
Avoid food and drink that triggers their symptoms until they have their gallbladder or gallstones removed
Do not need to avoid this food and drink after surgery.
Seek further advice if eating or drinking triggers existing symptoms or causes new symptoms to develop after they have recovered from having their gallbladder or gallstones removed.
Treatment of gallstones
Surgical removal if symptoms develop
Mild-moderate pain: paracetamol or NSAID
Severe pain: IM diclofenac or morphine/pethidine
Ursodeoxycholic acid has been used but no evidence behind it
What is primary biliary cholangitis?
Chronic cholestatic disease which develops due to progressive destruction of small and intermediate bile ducts within the liver, subsequently evolving to fibrosis and cirrhosis
Treatment of primary biliary cholangitis?
Ursodeoxycholic acid (even asymptomatic patients)
Liver transplantation can be considered with advanced disease
Role of Ursodeoxycholic acid in the treatment of primary biliary cholangitis
Slows disease progression but the effect on overall survival is uncertain
What is inborn errors of primary bile acid synthesis?
Group of diseases in which the liver does not produce enough bile acids due to enzyme deficiencies
Which acids would you be deficient in with inborn errors of primary bile acid synthesis?
Main components of bile: cholic acid and chenodeoxycholic acid
Treatment of inborn errors of primary bile acid synthesis. Role of these drugs?
Cholic acid; where there is deficiency of two specific liver enzymes
Acts by replacing some of the missing bile acids
Chenodeoxycholic acid; where there is deficiency of one specific enzyme in the bile acid synthesis pathway when presenting as cerebrotendinous xanthomatosis
Urosdeoxycholic acid (Unlicensed)
Treatment of inborn errors of primary bile acid synthesis due to inborn deficiency of two specific liver enzymes
Cholic acid
