Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Saaliha Part 4 – PM4B > (SYNOPTIC) Liver Disease & Management > Flashcards

(SYNOPTIC) Liver Disease & Management Flashcards

1
Q

What percentage of the liver is comprised of hepatocytes?

A

60%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

How many blood supplies does the liver have?

A

2

Hepatic artery (from heart)
Portal vein (blood from the bowel)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the functions of the liver?

A

(1) Metabolism
(2) Synthesis
(3) Immunological
(4) Storage
(5) Secretion
(6) Homeostasis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are some examples of substances metabolised in the liver?

A
  • Products of digestion
  • Bilirubin
  • Steroid hormone
  • Insulin
  • Aldosterone
  • Vitamin D
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is synthesised in the liver?

A
  • Plasma proteins
  • Clotting factors
  • Cholesterol
  • Urea (from amino acids)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is stored in the liver?

A
  • Fat soluble vitamins
  • Glycogen
  • Blood reservoir
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is secreted in the liver?

A

Bile + bile salts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the function of the liver in homeostasis?

A

Glucose regulation

Conversion of glucose to glycogen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are some potential causes for chronic liver disease?

A
  • alcohol
  • NAFLD/ NASH
    ø Non-alcoholic fatty liver disease
  • immune/ autoimmune
  • drugs
  • malignancy
  • HCV/ HBV
    ø Hep C + Hep V
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are some potential causes for acute liver disease?

A 
- HAV/ HBV/ HEV
  ø 3rd trimester of pregnancy
- Drugs
- TPN
- Infection, e.g. malaria
- Ischaemia
- Alcoholic hepatitis
- Acute fatty liver of pregnancy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What increases risk of non-alcoholic fatty liver disease?

A
  • T2DM
  • Obesity
  • Dyslipidaemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What may be the first presentation of NAFLD?

A

Cirrhosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is the non-pharmacological management of NAFLD?

A
  • Weight loss
  • Healthy diet
  • Exercise
  • Smoking/ alcohol cessation
  • 2-3 cups of black coffee daily
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the pharmacological management of NAFLD?

A
  • Statins

- Treat HTN/ T2DM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What co-morbidities can make a HepC (HCV) infection worse?

A

(1) HIV
(2) Underlying cirrhosis
(3) Liver transplant
(4) Lifestyle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the process of chronic liver disease development?

A

(1) Insult
- e.g. toxin/ virus
(2) Hepatitis or steatohepatitis
(3) Reversible
- if cause is stopped, e.g. alcohol cessation
(4) If insult is not removed
(5) Fibrosis
- scarring + thickening of smooth muscle
(6) Cirrhosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What is the general classification of liver disease?

A

(1) Compensated
- Asymptomatic due to medication/ sufficient healthy liver tissue for normal function
(2) Decompensated
- Symptomatic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What is a liver function test?

A

Used to identify patients struggling with liver/ biliary tract disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What is a downside of liver function tests when checking for liver disease?

A

Some LFTs reflect liver DAMAGE rather than function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What results from a liver function test are considered a cause for concern?

A

3 times the upper limit of normal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

How should a liver function test be used?

A

(1) Look for trends

(2) Do not use in isolation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What would a liver function test (LFT) show in acute hepatocellular damage?

A 
HIGH - plasma ALT
HIGH - plasma AST
HIGH - bilirubin (unconjugated)
PROLONGED - prothrombin time
NORMAL - albumin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What would a liver function test (LFT) show in chronic hepatocellular damage?

A

NORMAL - ALT
NORMAL - AST
LOW - albumin
PROLONGED - prothrombin time

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What would a liver function test (LFT) show in cholestasis (blockage of bile duct)?

A

HIGH - plasma ALP

HIGH - bilirubin (conjugated)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What other investigations can be done alongside a liver function test (LFT)?
(1) Ethanol (2) Drug history (3) FBC (4) Clotting (5) U+Es (6) Liver ultrasound (7) Biopsy (8) Liver screen - if obstruction ruled out - check for viral causes
26
How is acute liver failure graded?
(1) Hyperacute - 6-7 days (2) Acute - 8-28 days (3) Subacute - 29-84 days
27
In which liver failure grade(s) is cerebral oedema rare?
Subacute
28
In which liver failure grade(s) is cerebral oedema common? Hyperacute/ acute/ subacute
(1) Hyperacute | (2) Acute
29
What is the prognosis for each liver failure grade?
Hyperacute - moderate Acute - Poor Subacute - Poor
30
What is used to grade chronic liver disease?
(1) Child's Pugh Score (2) MELD - Model for end-stage liver disease - OR UKELD
31
What are the grades for chronic liver disease using the Child's Pugh Score?
(1) A 5-6 points COMPENSATED (2) B 7-9 MODERATE (3) C 10-15 ADVANCED
32
What is the MELD score used for?
Determining the mortality of end-stage liver disease
33
What are some common symptoms of liver disease?
(1) Jaundice - yellowing of eye (2) Spider nevi in upper chest (3) Ascites - accumulation of fluid in peritoneal cavity (4) Clubbing of nails (5) Dilated abdominal veins (6) Ankle oedema (7) Bleeding tendency due to decreased prothrombin time
34
Which blood vessel brings blood to the liver from the heart?
Hepatic artery
35
Which blood vessel brings blood to the liver from the bowel?
Portal vein
36
How many general functions of the liver are there?
6
37
What are the general functions of the liver?
(1) Homeostasis (2) Storage (3) Metabolism (4) Immunological (5) Secretion (6) Synthesis
38
Name some causes of chronic liver disease.
- Alcohol - NASH/ NAFLD - Drugs - Malignancy - Autoimmune - HCV/ HBV - Metabolic, e.g. haemochromatosis
39
Name some causes of acute liver disease.
- Drugs - TPN - Ischaemia - Infection - Alcoholic hepatitis - Acute fatty liver of pregnancy
40
What is non-alcoholic fatty liver disease?
A range of liver diseases From simple fatty liver -> Non-alcoholic seato-hepatitis -> Fibrosis/ cirrhosis
41
What are some risk factors for NAFLD?
- Diabetes - Obesity - Dyslipidaemia (metabolic syndrome)
42
What is the non-pharmacological management for NAFLD?
- Weightloss - Healthy diet - Exercise - Stop smoking/ alcohol - 2-3 cups of black coffee daily
43
What is the pharmacological management for NAFLD?
- Treat BP - Treat diabetes - Statins
44
What patient groups are at higher risk of Hepatitis B?
- IV drug users - Casual sex - Close family members - Babies born to infected mothers - HCPs
45
What are the stages of progression of chronic liver disease?
(1) Insult - e.g. toxin/ virus (2) Hepatitis/ steatohepatitis (3) Reversible - liver is regenerating (4) Insult not removed (5) Fibrosis - thickening + scarring (6) Cirrhosis - chronic liver disease
46
What is compensated chronic liver disease?
Asymptomatic Sufficient meds/ tissue to continue normal function
47
What is decompensated chronic liver disease?
Symptomatic
48
What result of a LFT is considered to be cause for concern?
3x upper limit of normal
49
What LFT results would be expected in acute hepatocellular damage?
- Large rise in ALT + AST - 2y rise in unconjugated bilirubin - Prolonged PT - Normal albumin
50
What LFT results would be expected in chronic hepatocellular damage?
- Fairly normal ALT + AST - Prolonged PT - Low albumin
51
What LFT results would be expected in cholestasis?
- Rise in ALP | - Rise in conjugated bilirubin
52
What is cholestasis?
Blockage of the bile duct
53
Name some other investigations that can be carried out to determine liver damage/ function, alongside LFTs.
- Ultrasound of liver - Biopsy - Liver screen (if known no obstruction)
54
What are the grades of acute liver failure?
(1) Hyperacute (2) Acute (3) Subacute
55
How many grades of acute liver failure are there?
3
56
What is the time from jaundice to encephalopathy in hyperacute liver failure?
6-7 days
57
What is the time from jaundice to encephalopathy in acute liver failure?
8-28 days
58
What is the time from jaundice to encephalopathy in subacute liver failure?
29-84 days
59
In which grades of acute liver failure is cerebral oedema common?
- Hyperacute | - Acute
60
When does renal failure occur in hyperacute liver failure?
Early
61
When does renal failure occur in acute liver failure?
Late
62
When does renal failure occur in subacute liver failure?
Late
63
What is ascites?
Abnormal fluid buildup in the abdomen.
64
In which acute liver failure types is coagulation disorder considered marked?
Hyperacute and acute
65
What is the prognosis of hyperacute liver failure?
Moderate
66
What is the prognosis of acute liver failure?
Poor
67
What is the prognosis of subacute liver failure?
Poor
68
What is the Child's Pugh Score used for?
Grading of chronic liver disease (cirrhosis)
69
How is cirrhosis graded?
(1) Child's Pugh Score | (2) MELD/ UKELD
70
Name some symptoms of liver cell failure.
- Coma - Spider nevi - Gynecomastia ø enlargement of male breasts - Jaundice - Ascites - Loss of sexual hair - Testicular atrophy - Bleeding tendency ø decreased prothrombin - Anaemia - Ankle oedema
71
Name some symptoms of portal hypertension.
- Oesophageal varices - Gastropathy ø melaena - Splenomegaly - Dilated abdominal veins - Ascites - Haemorrhoids (rectal varices)
72
What are some causes of ascites?
- Impaired aldosterone metabolism - Low albumin - Reduced renal blood flow - Portal hypertension - Increased hepatic lymph production
73
Which drugs, generally, can exacerbate ascites and peripheral oedema?
- NSAIDs - Salt - Saline
74
What is the treatment for ascites?
(1) Fluid + salt restriction (2) Spironolactone - aldosterone antagonist (3) Furosemide - for peripheral oedema (4) Paracentesis - Removal of peritoneal fluid (5) TIPSS - connect portal vein to hepatic vein in the liver (6) Peritoneo-venous shunt - peritoneal fluid from peritoneum into veins
75
What is hepatic encephalopathy?
Reversible changes in mental state 2y to failure of liver, due to inability to metabolise toxins
76
What are the stages of hepatic encephalopathy?
(1) Forgetfulness/ confusion/ agitation - > (4) Coma + unresponsive to painful stimulus
77
How many stages of hepatic encephalopathy are there?
4
78
What is the treatment of hepatic encephalopathy?
- Remove/ avoid precipitants - Reduce protein intake - Decrease bacterial ammonia production - Increase elimination of bacteria ammonia production
79
What is the pharmacological treatment for hepatic encephalopathy?
(1) Lactulose - prevents constipation, inhibits colonic bacteria (2) Phosphate enemas (3) Rifaximin - poorly absorbed Abx, eliminates colonic bacteria
80
What is pruritus?
Severe itching of the skin
81
How does chronic liver failure cause pruritus?
- Bile acid build up in the skin
82
What is the pharmacological treatment for pruritus, secondary to liver failure?
(1) Chlorphenamine, be careful due to masking hepatic encephalopathy (2) Menthol in aqueous cream
83
How is VTE risk evaluated in liver failure?
PT Prothrombin time
84
Which administration route should be avoided in VTE, secondary to liver failure?
IM Can lead to haematoma
85
What is a variceal haemorrhage?
Bleeding of varices in GIT
86
What causes a variceal haemorrhage?
(1) Decrease blood flow through liver (2) Portal HTN (>12mmHg) (3) Collateral vessels (4) GIT varices
87
What is DILI?
Drug induced liver injury
88
What are the types of DILI?
(1) Type A - intrinsic | (2) Type B - idiosyncratic
89
Describe Type A (intrinsic) DILI (drug induced liver injury)
- Predictable - Dose related - Occurs rapidly - Causes necrosis/ acute liver - Can occur at lower doses if LD already - Direct toxicity of drug/ metabolite - Often identified in clinical trials - Reproducible in animal models
90
Describe Type B (idiosyncratic) DILI.
- Unpredictable - May/ may not be dose related - Tends to take longer to occur (weeks->months) - Often more frequent if pre-existing LD - Accounts for >90% of cases
91
What website/ source can be used to identify causative agent(s) of drug-induced liver injury (DILI)?
LiverTox
92
What drug class has the highest incidence for causing DILI?
Antimicrobials
93
What drug class has the second highest incidence for causing DILI?
Herbal and dietary supplements
94
Which metabolite of paracetamol is toxic?
NAPQI
95
What is the antidote for paracetamol?
N-acetylcysteine
96
What are inducers of P450 enzymes in the liver?
- Carbamazepine - St John's Wort - Phenytoin - Rifampicin - Ethanol
97
What are inhibitors of P450 enzyme in the liver?
- Erythromycin - Amiodarone - Protease inhibitors - Ciprofloxacin
98
What are some prescribing tips for drugs and the liver?
- Most drugs are safe in stable liver disease - Use older + more established drugs - Avoid drugs - Start with small dose and increase slowly - Choose best option and monitor clinical response
99
Which analgesics should be actively avoided in hepatic impairment?
NSAIDs + COX2 inhibitors
100
For which analgesics should there be caution when used in hepatic impairment?
Opioids e.g. codeine is metabolised to active form in the liver
101
Are tricyclic antidepressants suitable in hepatic impairment?
Yes, at low doses
102
How should neuropathic pain be treated in hepatic impairment?
Gabapentin is suitable
103
What should be the antidepressant choice in hepatic impairment?
- Sertraline/ citalopram - TCAs should be avoided due to sedating effect - Mirtazepine is also suitable, due to low bleeding risk but has a sedating effect
104
When should statins be avoided in hepatic impairment?
(1) Acute liver disease | (2) Decompensated chronic liver disease
105
How can seizures from alcohol withdrawal be prevented?
Benzodiazepine - Chlordiazepoxide - Diazepam - Lorazepam
106
What is chlordiazepoxide?
Anxiolytic + anticonvulsant
107
When should a chlordiazepoxide dose be reassessed, when used in alcohol withdrawal?
If >3 PRN doses are required in 24hrs
108
On a flexible chlordiazepoxide regimen, for alcohol withdrawal, what should the review criteria be?
Calculate every 2-4hrs depending on severity
109
Is this drug long, intermediate, or short-acting? Diazepam
Long-acting
110
Is this drug long, intermediate, or short-acting? Lorazepam
Short/ intermediate-acting
111
Is this drug long, intermediate, or short-acting? Oxazepam
Short/ intermediate-acting
112
Is this drug long, intermediate, or short-acting? Chlordiazepoxide
Long-acting

Saaliha Part 4 – PM4B (73 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions