Liver therapeutics Flashcards
1
Q
Acute Disease
A
- supportive: plasma and vit K
2
Q
write out hepatocellular injury diagram
A
draw it!
3
Q
anti-oxidents
- what
- method of action
- use (2)
A
s-adenomethionine (SAME-e)
- pre cursor of glutathione (liver antioxidant)
- can’t give glutithione as it won’t pass through the stomach wall
- membrane stabilising
- anti- inflammatory
use:
- drug toxicities
- inflammatory disease
(acute disease)
4
Q
Vitamin E
A
- effective with chronic hepatitis
- can be specifically used in copper toxicities
5
Q
Urosodeoxycholic acid (desolit)
- what
- method of action
- contraindication
A
- synthetic hydropic bile acid
- in choleostasis (form pancreatitis/anorexia/liver inflammation) can get membrane and lipid damage
- this stimulates bile flow
- antiapoptotic
- contraindicated with biliary obstruction!
6
Q
N- Acetylcysteine
A
- precursor of cysteine –> glutathione
- increase in hepatic blood flow
- must be given IV with fluids
- can cause histamine release (GIT effects)
- good in paracetamol toxicity: binds to toxin and increases glucorinidation
7
Q
Milk Thistle (5)
A
- silymonin
- anti- fibrotic
- anti- inflammatory
- anti- oxidant
- good with mushroom toxicity
8
Q
Vitamin K (4)
A
- fat soluble vitamin
- activates clotting factors
- bile is necessary for it’s absorption (give SC rather than oral)
- good for rat poisonings
9
Q
Pathogenesis of chronic liver disease (3)
A
- increase in AST/ALT
- cirrhosis develops along with scar formation
- blood supply to liver decreases –> portal vein hypertension –> portal vein becomes distended –> ascites –> back flow into GT tract –> predisposed to gastric ulceration
10
Q
Hepatic Fibrosis
A
- unavoidable in chronic liver disease
- inflammation –> cytokine release –> collagen production –> collagen build up –> impedes blood flow –> portal vein hypertenion
11
Q
Anti- fibrotic drugs (for hepatic fibrosis) (5)
A
- SAM-e
- vit E
- colchicine
- prednisilone
- azathioprine
12
Q
colchicine (2)
A
- has potential to reverse fibrosis
- reserved for moderate/marked cases as has bad side effects: anorexia (drug cessation), BM suppression, diarrhoea
13
Q
Corticosteroids
- effects (3)
- indications (3)
- contraindications (3)
A
- anti- inflammatory
- anti- fibrotic
- immunomodulatory
indications:
- inflammation with no underlying disease
- chronic hepatitis
- cholangitis in dogs (lymphocytic)
contraindications:
- hepatic encepahlopathy ** –> steroids cause protein break down and add to problem
- gastric ulceration (portal hypertension)
- anti- insulin in cats
14
Q
Ascites
- causes (3)
- treatment (2)
- Caution
A
Causes:
- portal hypertension
- hypoalbuminaemia
- paracentesis
Treatment:
- frusemide (K sparing)
- spirinolactone (K sparing)
CAUTION:
- GI consequences can be fatal
- use H2 antagoinsist (NOT cimetidine which is degraded by the liver), omprazole and sucralfate
15
Q
Hepatic encephalopathy
- why
- types
- management
A
young dog with shunt/old dog with advanced liver failure
portosystemic shunts:
- 70% congenital
- acquired shunts due to portal hypertension and body finds an alternate route for blood
- portal vein accesses systemic circulation so the blood bypasses the liver
- extrahepatic or intrahepatic
- most are macroscopic and can be ligated
- some are microscopic and can be medically managed
