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The Patient - Semester 2 > The Patient Sem 2 - The Liver > Flashcards

The Patient Sem 2 - The Liver Flashcards

1
Q

What is the largest single organ?

A

Liver

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2
Q

What are the two blood supplies to the liver?

A 
Arterial blood (20% hepatic artery) 
Venous blood (80% portal vein)
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3
Q

Name five liver functions:

A

METABOLISM- drugs, hormones, bilirubin

SYNTHESIS - proteins, clotting factors, fibrinogen, cholesterol

CLEARANCE- bilirubin, drugs, toxins

PRODUCTION OF BILE - secretion of bile salts

STORAGE - fat soluble vitamin ADEK

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4
Q

Explain the classifications of liver disease:

A
  1. Cholestatic liver disease/cholestasis
    - Disruption of bile flow (stagnation of bile in bile ducts)
    - Can be intrahepatic or extra hepatic
    - Increases bilirubin, alkaline phosphate
  2. Hepatocellular ideasse - injury to hepatocytes e.g. toxins, viruses
    - Fatty infiltration
    - Inflammation - hepatitis
    - Increase in transaminase enzymes GGT, bilirubin
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5
Q

What is fibrosis?

A

active deposition of collagen formation of scar tissue - this can disrupt blood flow.

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6
Q

What is acute liver disease?

A

History of onset of symptoms doesn’t exceed 6 months

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7
Q

What is chronic liver disease?

A
  • Persists more than 6 months
  • Permanent structural changes
  • Most common cause = alcohol and chronic viral hepatitis
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8
Q

What is bilirubin?

A

Product of RBC breakdown.
Usual range = 5-20micromol/L
Transported to the liver in the serum attached to albumin.

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9
Q

What level of bilirubin indicates jaundice?

A

50micromol/L

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10
Q

What are the transaminases that give indication of liver function?

A
  1. ) Aspartate transferase (AST)
    - usual range = 0-40 iu/L
    - Found in liver, heart, skeletal muscle, pancreas, kidney and RBC
  2. ) Alanine transferase (ALT)
    - Usual range 5-30 iu/L
    - LIVER specific
    - When liver cells are damaged they burst and release these enzymes
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11
Q

What is ALP?

A

Alkaline phosphate.
Normal range = 20-120iu/l
Found in liver, bone and intestine and placenta

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12
Q

What is yGT?

A

y- Glutamyltransferase (GGT)

  • Normal range = 5-55 iu/L
  • Found in liver, biliary epithelial cells, pancreas, kidneys, intestine
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13
Q

What is Albumin?

A

One of the proteins produced by the liver.

Normal range 35-50 g/dL

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14
Q

What do decreased albumin levels indicate?

A

Oedema.

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15
Q

How to interpret LFT’s.

A

If liver dysfunction - usually at least 2 will be deranged.

LFT’s aren’t always abnormal even in patients with cirrhosis.

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16
Q

Other liver investigations apart from LFT’s?

A
  • Fibroscan
  • Liver biopsy
  • Imaging e.g MRI, CT scan
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17
Q

What are some symptoms of liver disease?

A
  • Fatigue
  • General Malaise
  • Fever
  • Nausea
  • Vomitting
  • Jaundice
  • Pale stool and dark urine
  • Pruritus
  • Finger clubbing
  • Brusing and bleeding
  • Liver problems
  • Encephalopathy
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18
Q

What is ascites?

A

Accumulation of fluid in the peritoneal cavity leading to a swollen abdomen

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19
Q

What are the three theories for the cause of ascites?

A
  • under fill
  • Over fill
  • Peripheral artery restrictionm
20
Q

Treatment of ascites?

A

Diuretics–>

  • spironolactone 100-600mg OD
  • Furosemide 40 -160mg daily

Important to take daily U+E’s esp Na, K, Cr

21
Q

What is spontaneous bacterial peritonitis?

A
  • Infection of ascitic fluid without intra-abdominal source of sepsis.
  • Neutrophil count >250 cells per mm3
  • Mortality rate is approx 40%
22
Q

What is hepatic encephaolopathy

A

Spectrum of neuropsychiatric changes in mood and behaviour, confusion, poor sleep rhythm and eventually
delirium and coma.

  • Similar symptoms to alcohol intoxication/withdrawal
23
Q

Theory behind cause of hepatic encephalopathy?

A

Accumulation of toxins esp ammonia, increased levels of NT’s

24
Q

How do you treat hepatic encephaolopathy?

A

Treatment involves avoidance of precipitants and lowering ammonia levels therefore:

  • LAXATIVES (e.g. lactulose liquid) BD-TDS
  • Antibiotics (metronidazole, neomycin, sodium benzoate)
25
Q

What is portal hypertension and varices?

A
  • Caused by increased resistance to flow due to disruption of hepatic architecture and compression of hepatic venules by regenerating nodules.
  • Collateral vessels (varices) form in the stomach or oesophagus and enable food to bypass the liver.
26
Q

Treatment of portal hypertension and varices?

A
  • Medical emergency (large blood loss)
  • Aim to stop bleeding and replace lost blood
  • Resuscitation
  • Endoscopy
  • Balloon tamponade

Medication

  • Terlipressin (a potent vasoconstrictor) - IV 1.2mg bolus then ever 4-6 hours
  • IV broad spec antibiotic for at least 5 days
  • PPI

Secondary medication:

  • Propanolol tablets 20-40mg BD
  • Non selective beta blocker
27
Q

What is pruritus?

A

Build up of bile salts

28
Q

Treatment of pruritus:

A
  • Colestyramine
  • UDCA
  • Antihistamines (cetrizine)
  • Topical calamine lotion
  • Rifampicin
29
Q

What are some causes of liver disease and dysfunction?

A
  • Alcohol
  • Viral infections
  • NAFLD
  • Drugs and toxins
  • Inherited and metabolic disorders –> Wilson disease
  • Immune disease of the liver- autoimmune hepatitis, PBC, PSC
  • Vascular abnormalities
  • Cancer
  • Biliary tract disorders
30
Q

What are the two type of drug reactions on the liver?

Explain

A

Intrinsic reactions (type A)

  • Predictable
  • Dose dependent
  • Tend to occur rapidly
  • e.g. paracetamol

Idiosyncratic reactions (type B)

  • Not predictable
  • Not reproducible
  • Not dose dependent
  • Tend to take longer to occur
  • Can cause any type of liver injury
31
Q

What idiosyncratic drug reaction can methotrexate cause?

A

Cirrhosis/Fibrosis

32
Q

What idiosyncratic drug reaction can Warfarin cause?

A

Cholestasis.

33
Q

Maximum recommendation of alcohol per week?

A

14 units.

34
Q

How is alcohol withdrawal treated?

A

Combo sedatives and vitamin supplementation –> chlordiazepoxide and pabrinex IV or oral vitamin B

35
Q

What is chlordiazepoxide?

A
  • Sedative
  • Long 1/2 life
  • Low potency
  • PRN
36
Q

Why is vitamin supplementation used in alcohol withdrawal?

A
  • Treat potential thiamine deficiency
  • Thiamine deficiency can cause wernickes encelopahy
  • Alcohol prevents thiamine absorption
37
Q

What is hepatitis A?

A
  • Most common
  • Faecal to oral route
  • Doesn’t progress to chronic
38
Q

What is hepatitis B

A
  • Enveloped DNA virus with 8 subtypes

- Highly contagious - present in blood. saliva, urine, semen and vaginal fluids.

39
Q

How is Hep B diagnosed?

A
  • Hep B surface antigen
  • Hep B core antigen
  • Antibody to Hep B core
  • HBV DNA level
  • Hep B e antigen
  • ALT levels
40
Q

How is chronic Hep B treated?

A
  • Antivirals e.g. enetecavir
  • Pegylated interferon
  • Vaccination available
41
Q

How is Hepatitis D acquired?

A
  • Same way as Hep B

- Hep D can only replicate in presence of Hep B

42
Q

What is Hepatitis E?

A
  • Similar course to Hep A
  • Enterically transmitted - faecal to oral route
  • Often mild
43
Q

What is Hepatitis C?

A
  • Blood Bourne
  • 6 major genotypes
  • '’Silent killer”
44
Q

How is hepatitis C diagnosed?

A

Testing done for Hep C antibodies, HCV RNA and genotype.

45
Q

Is Hep C curable?

A

Yes

46
Q

Newish treatment for Hepatitis C?

A

Sofosbuvir (interferon free)

The Patient - Semester 2 (4 decks)

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