SA Liver

Question 1

Principles of Tx

Answer 1

Eliminate causative agent
Supress ongoing disease
Optimise regenerative capacity
Control complications

Question 2

Therapy based on biopsy results

Answer 2

Inflammation
-Neutrophil - AB
-Lymphocytes - Imm Suppression
Fibrosis- A-Fibrotics
Cu accumulation- decoppering
Bac culture - AB

Question 3

Dietary management

Answer 3

Hepatic encephalopathy- lower NH3 production
-Protein restriction
Chr active Infl- reduce infl, less Cu
-alter mineral balance
-fat soluble vits

Question 4

Glucocorticoid therapy

Answer 4

Chr active Infl- lymphocytes and plasma cells on biopsy
Hepatic fibrosis- biopsy fibrosis
Adv-
better well being, stim appetite, Immunosuppression, Anti-fibrotic
Dis- steroid hepatopathy, Dz vulnerability, fluid retention

Question 5

Cu tox Tx

Answer 5

Chelators-
D-penicillamine
Absorption blockers-
Oral Zn

Question 6

Adjunctive therapy

Answer 6

Costly, broad measure
Ursodeoxycholic acid
-hydrophylic bile, better flow (not if complete obst.)
S-Adenosyl methionine
-GSH production precursor, detox

Question 7

ABs liver

Answer 7

Bacterial cholangiohepatitis-
-Biopsy +culture-> Ab (metro)
Hepatic encephalopathy-
-CS, PTH, image->AB (metro)

Question 8

Specific therapies liver

Answer 8

Immune med- Biopsy->Preds
Fibrosis- biopsy->Preds
Cu accumulation- breed biopsy->Penicillamine/ Zn

Question 9

Hepatic encephalopathy

Answer 9

ID and treat precipitating cause
-Dehydration, alkalosis, HypoK, GI haemorrhage
Lower NH3-
-Less protein diet, lactulose, AB
Lactulose retention enema (coma)

Question 10

Ascites and oedema

Answer 10

Low Na diet
Diuretics - spironolactone
Paracentesis - minimal vol., could lower body protein levels

Question 11

Haemorrhage and anaemia

Answer 11

Vit K injections
Fresh blood transfusion
B vitamin injections
Acid blockers