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RB Y1 GI > physiology and pharmacology of the Liver > Flashcards

physiology and pharmacology of the Liver Flashcards

1
Q

what is a marker of liver function

A

albumin and PT time

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2
Q

low albumin is a sign of what

A

CHRONIC LIVER problems and malnutrition

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3
Q

what is hypoalbuminaemia also found in

A

hypercatabolic states (e.g. trauma with sepsis) and in diseases associated with an excessive loss (e.g. nephrotic syndrome, protein-losing enteropathy)

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4
Q

what does the liver do

A

STORES

fat soluble vitamins - ADEK and B12

copper and iron

glycogen

DEGRADES

insulin, steroid hormones, ADH and glucagon

activates vitamin D to 25(OH)D

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5
Q

where is albumin made and what does it do

A

in the liver

regulates the oncotic pressure of blood and transports water-insoluble substances such as bilirubin, hormones, fatty acids and drugs

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6
Q

what cagoulation factors does the liver produce

A

factor II, VII, IX and X

protein C and S

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7
Q

what are the protective liver cells

A

Kupffer

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8
Q

what do Kupffer cells do

A

digest/destroy cellular debris and invading bacteria

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9
Q

what happens to bile between meals

A

stored and conc in gall bladder

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10
Q

what is the sphincter of Oddi like between meals

A

closed

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11
Q

during a meal what happens to gall bladder

A

chyme in duodenum stimulates gall bladder smooth muscle to contract via CCK and vagal impulses

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12
Q

during a meal what is sphincter of Oddi like

A

opens via CCK

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13
Q

what happens to bile during meal

A

spurts into duodenum via cystic duct and common bile duct

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14
Q

what does bile participate in

A

the digestion and absorption of fats

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15
Q

what is the composition bile

A

bile acids cholic and chenodeoxycholic acids form bile salts with Na and K

bilirubin

IgA

cholesterol

phospholipids and lipids

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16
Q

what is another name for gallstones

A

cholelithiasis

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17
Q

what is the best surgery for symptomatic gallstones

A

laparoscopic cholecystectomy

18
Q

what drug can be given for gallstones

A

ursodeoxycholic acid

19
Q

what are the indications for ursodeoxycholic acid

A

small or mediums sized stones unimpaired gall bladder function

20
Q

what is biliary colic

A

pain due to gallstone temporarily blocking the bile duct

21
Q

what are the analgesic options for biliary colic

A

morphine buprenorphine or pethidine

22
Q

why is morphine preferred

A

Although morphine causes sphincter of Oddi to contract more it is a better analgesia and not contraindicated

23
Q

what drugs would you use to relive biliary spasm

A

atropine and GTN

24
Q

what happens to 5% of bile salts entering duodenum

A

lost in faeces

25
Q

what happens to most of the bile salts entering duodenum

A

reabsorbed in the terminal ileum and undergo enterohepatic recycling

26
Q

explain bile acid sequestrant mechanism

A

Trap the bile salts in the intestine, increasing their excretion resulting in more cholesterol to be converted to bile salts by interrupting enterohepatic recycling.

Prevent the reabsorption of bile salts.

The fall in hepatocyte cholesterol concentration causes compensatory increase in HMG CoA reductase activity and the number of LDL receptors (main mechanism in which they lower cholesterol).

27
Q

adverse effects of bile acid sequestrants

A

are confined to the gut, because the resins are not absorbed; these effects include bloating, abdominal discomfort, diarrhoea and constipation.

28
Q

bile acid sequestrates are use in

A

hyperlipidaemia and choelstatic jaundice

29
Q

what size of dose required

A

large

30
Q

bile acid sequestrates can cause deficient of what

A

fat soluble vitamins

31
Q

what drugs have unchanged activity during metabolism

A

diazepam to nordiazepam

32
Q

compare aspirin and its metabolites activity

A

aspirin - anti inflammatory and anti platelet

metabolite - anti inflammatory

33
Q

what is the name of aspirins metabolite

A

salicylate acid

34
Q

name some reactions that happen in phase 1 of drug metabolism in liver

A

oxidation hydrolysis reduction

35
Q

name some reactions that happen in phase 2 of drug metabolism in liver

A

conjugation

36
Q

what do the CYP450 family of monooxygenases do

A

mediate oxidation reactions (phase 1) of many lipid soluble drugs in the liver

37
Q

what is hepatic encephalopathy

A

the occurrence of confusion, altered level of consciousness, and coma as a result of liver failure

38
Q

explain hepatic encephalopathy pathophysiology

A
  • liver fails - nitrogenous waste builds up as ammonia in the circulation - passes t brain - cleared by astrocytes - excess glutamine causes an osmotic imbalance and a shift of fluid into these cells - cerebral oedema
39
Q

hepatic encephalopathy - treatment

A

lactulose

40
Q

lactulose is what type of laxative

A

osmotic

41
Q

lactulose effects

A

retain water - inc bulk - inc peristalsis

42
Q

antibiotics used in hepatic encephalopathy

A

neomycin rifaximin

RB Y1 GI (54 decks)

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