Liver Miscellaneous

Question 1

What is the child-pugh classification?

Answer 1

Score measuring the level of liver dysfunction measuring the bilirubin, albumin and prothrombin time

Question 2

What is alcohol metabolized to?

Answer 2

Acetaldehyde in the cytosol and to acetate in the mitochondria of the liver cells

Question 3

Pain management for liver disease?

Answer 3

• NSAIDs (not ideal for patients with cirrhosis)
• Opiates
• Paracetamol (LOW DOSE if you have to give it)

Question 4

Example of opiate?

Answer 4

FENTANYL

Only safe one for use

Question 5

Mechanism of NSAIDs?

Answer 5

Stops the prostaglandin production in the kidney which worsens the renal impairment, increases sodium retention, increases risk of hepato-renal syndrome and worsens heart failure

Question 6

Higher risk of______ when taking NSAIDs?

Answer 6

Peptic ulcers

Question 7

If you HAVE to give NSAIDs to a cirrhosis patient what do you ideally give with it?

Answer 7

PPI

Question 8

Leading cause of acute liver failure?

Answer 8

Paracetamol toxicity

Question 9

What is paracetamol metabolized to?

Answer 9

Sulphates and glucuronides

Highly reactive intermediate step which is toxic to liver cells

Question 10

What happens to intermediate step of paracetamol metabolism in healthy people?

Answer 10

Immediately inactivated by glutathione

Question 11

In liver disease there are reduced ___ stores and so there us toxicity with normal ___ so give low dose if viable.

Answer 11

Glutathione

Paracetamol

Question 12

What do loop diuretics cause?

Answer 12

Reduced intra-vascular volume
Hypokalaemia
Hypomagnesaemia

Question 13

Example of loop diuretics?

Answer 13

Furosemide

Question 14

What do thiazide diuretics cause?

Answer 14

Hypokalaemia

Hypomagnesaemia

Question 15

Medications for liver generally?

Answer 15

Pain relief
Diuretics
Sedation
ABs