Week 3 Liver - Forrester Flashcards
The Healthy Liver
- helps fight infections and cleans the blood.
* helps digest food and stores energy
Inflammation
- swelling of the liver (hepatitis), is usually the first stage of liver disease
- If inflammation continues over time can cause scarring in the liver
Fibrosis
• scarring of the liver
• If left untreated, the inflamed liver will start to scar
• Scar tissue can prevent blood from flowing through the
liver
Cirrhosis
- Scarring of the liver – hard scar tissue replaces soft healthy tissue
- If cirrhosis is not treated, the liver will fail
Liver Cancer
Cirrhosis and hepatitis B are leading risk factors
liver failure
• Liver is losing or has lost all of its function (lifethreatening condition)
-means that the liver has been failing gradually
for some time
acute liver failure especially after
acetominophen overdose
Nonalcoholic fatty liver disease (NAFLD)
buildup of fat in the liver two types: o Nonalcoholic fatty liver (NAFL) o Nonalcoholic steatohepatitis (NASH) • To be diagnosed with either form of NAFLD, a person must not have a history of heavy alcohol use or another problem that might be causing the liver condition (ex. hepatitis C) treatment: lifestyle management
o Nonalcoholic fatty liver (NAFL)
, a benign condition in which there is fatty infiltration but no inflammation
➢ In NAFL, the liver functions normally and there are no symptoms.
o Nonalcoholic steatohepatitis (NASH)
in which there is fatty infiltration along with liver inflammation
• although a similar condition can occur in people who abuse alcohol, NASH occurs in those who drink little to no alcohol
• The exact cause of NASH is unknown
➢ It occurs more frequently in people with certain medical conditions such as diabetes, obesity, and insulin resistance (this combination of disorders if often called the “metabolic syndrome”)
First symptoms of liver failure are often:
- Nausea
- Loss of appetite
- Fatigue
- Diarrhea
As liver failure progresses, symptoms may include:
- Confusion
- Extreme tiredness
- Coma
Direct Hepatotoxicity
Serum enzyme elevations without jaundice
• Acute hepatic necrosis is the most common form
• Elevations resolve when the drug is stopped or the dose is lowered
Idiosyncratic
- Caused by agents that have little or no intrinsic toxicity
* Cause liver injury only in rare cases
Acute hepatocellular hepatitis (Idiosyncratic Hepatotoxicity)
- Most common manifestation
- Latency period generally ranges from 5 to 90 days
- Ex. isoniazid, nitrofurantoin, and diclofenac
Cholestatic hepatitis (Idiosyncratic Hepatotoxicity)
- Characterized by pruritus and jaundice accompanied by moderateto-marked elevations in Alk phos levels
- Usually self-limited, and often protracted, but ultimately resolves
- Ex. amoxicillin–clavulanate, cephalosporins
Mixed Hepatitis (Idiosyncratic Hepatotoxicity)
- Caused by many agents
- Tend to have benign outcomes, rarely leading to liver failure
- Ex. Fluoroquinolones, macrolide antibiotics,
Bland cholestasis (Idiosyncratic Hepatotoxicity)
- Marked and prolonged jaundice with pruritus
- In women: typically caused by estrogens or oral contraceptives
- In men: typically caused by anabolic steroids
ACETAMINOPHEN TOXICITY - DOSING AND
WARNINGS
▪ Adult: 650-1000 mg Q4-6 hrs ▪ Children: 10-15 mg/kg/dose Q4-6 hrs ▪ FDA max: 4000 mg/day Acute toxicity: ≥ 7,500 mg single dose
glutathione and NAPQI
glutathione binds to NAPQI to form a nontoxic metabolite, which is then renally excreted
acute alcoholic intoxication or cirrhosis may increase
activity of cytochrome p450 and thus may be somewhat protected against acetominophen toxicity
ACETAMINOPHEN TOXICITY - treatment
activated charcoal
▪ N-acetyl cysteine (NAC) (oral or IV)
▪ N-acetyl cysteine (NAC) side effects
▪ IV- hypersensitivity reaction (10-20%); PO- vomiting (33%)
▪ Other: rash, itching
