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Clinical Physiology > Intestinal Failure and Liver Disease > Flashcards

Intestinal Failure and Liver Disease Flashcards

1
Q

How long is GI tract?

A

3-6m

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2
Q

vitamin D acronym

A

V-Vascular; I-Infectious/Inflammatory; T-Traumatic/Toxic; A-Autoimmune; M-Metabolic; I-Idiopathic; N-Neoplastic/Nutritional; D-Degenerative

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3
Q

bedside tests to assess nutritional status?

A

full history and examine inc temperature, rectal exam. ecg - mesenteric ischemia, blood glucose test, urinalysis

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4
Q

blood tests to assess nutritional status

A

hba1c -diabetes,
U+E - electrolyte imbalance,
CRP - inflammation,
FBC - microcytic anaemia from iron def, macrocytic anaemia from b12, folate deficiency, celiac screen,
LFT

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5
Q

microbiology to assess nutritional status

A

stool tests for celiac, h pylori

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6
Q

radiology to assess nutritional status

A

abdominal x-ray for dilatation

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7
Q

special/other tests to assess nutritional status

A

ct, endoscopy

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8
Q

management of ischemic bowel

A

laparotomy
excision of ischemic tissue
ostomy

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9
Q

nutritional implications pre surgery

A

not eating pre surgery - water soluble vitamin supply low

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10
Q

MUST score steps

A
  1. BMI
  2. weight loss
  3. acute sickness
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11
Q

How to improve nutrition?

A

artificial nutrition

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12
Q

nutritional implications of large amount of small bowel removed

A

more water = passed more easily
less absorption of macronutrients - parenteral nutrition and fluids

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13
Q

normal stoma output

A

600-1200ml per day

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14
Q

high output stoma

A

> 1500ml +dehydration

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15
Q

sodium is kept as high as possible using:

A

rehydration solution - hypertonic

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16
Q

nutritional approach

A

rehydration

encourage a hypercaloric diet - high salt high fat high protein

increase gastric pH

slow GI transit - loperamide, codeine

bile salt sequestrants

micronutrient replacement

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17
Q

management of short bowel syndrome

A
  1. determine length of bowel resected
  2. replace fluid loss and manage diarrhoea
  3. appropriate oral nutrition
  4. replace mineral and vitamin deficiencies
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18
Q

will a stoma patient open bowels?

A

no, some mucous discharge

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19
Q

causes of acute liver disease

A

viruses - hepatitis A,B,C,E,CMV,EBV
drugs - paracetamol, ecstasy, herbal remedies
autoimmune

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20
Q

cause of jaundice

A

increase in serum bilirubin

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21
Q

presentation of acute liver disease

A

jaundice
pale stools, dark urine
increased serum bilirubin
nausea
unwell
occassionally fever

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22
Q

features of cirrhosis

A

spider naevi, low platelets

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23
Q

high alkaline phosphatase and high gamma GT suggests?

A

bile duct disease - primary biliary cholangitis
acute - likely to be obstruction

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24
Q

liver function tests

A

Bilirubin
Albumin
Alanine transaminase
Aspartate transaminase
Alkaline Phosphatase
Gamma glutamyl transpeptidase
INR – measures factors II, VII, IX and X – all synthesized in liver

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25
Q

commonest causes of abnormal liver function tests?

A

fatty liver disease and alcohol

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26
Q

higher ast/alt ratio suggests

A

alcohol or significant fibrosis

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27
Q

treatable causes of liver disease

A

alcohol
viral hepatitis B, C, D,
autoimmune liver disease
celiac disease (causes abnormal LFT)
wilsons disease - caused by copper accumulation
iron toxicity
primary biliary cholangitis

28
Q

alanine transaminase and aspartate transaminase catalyse ______

A

aspartane and alanine

29
Q

unconjugated fraction of bilirubin binds to

A

serum albumin

30
Q

low serum albumin

A

infection, renal loss - nephrotic syndrome , impaired synthesis - severe liver disease, severe malnutrition

31
Q

very high transaminases signify

A

liver cell injury with release of enzymes into circulation e.g., acute viral hepatitis

32
Q

very very high transaminases

A

paracetamol overdose, ischemic hepatitis

33
Q

moderately elevated ALT and AST

A

fatty liver, cholangitis

34
Q

alkaline phosphatase is found in

A

liver, bone, biliary, placenta, intestine

35
Q

marked increase in alkaline phosphatase suggests

A

biliary obstruction, primary sclerosing cholangitis, primary biliary cholangitis

36
Q

what should you always check with inc alk phos

A

corresponding increase in gamma GT
if not measure alk phos isoenzymes

37
Q

very high gamma GT indicates

A

biliary obstruction, cholestasis, alcohol

38
Q

what is the fib4 score

A

indirect biomarker of liver fibrosis
calculated from alt, ast, platelet count and age

39
Q

causes of chronic liver disease

A

alcohol
chronic viral hepatitis B,C
fatty liver disease
autoimmune liver disease
other - iron overload, biliary disease, inherited disease

40
Q

chronic inflammation leads to ______

A

cell death, regeneration, fibrosis (scar tissue)

41
Q

alcohol is metabolised to

A

acetaldehyde and fat

42
Q

to develop alcohol related cirrhosis need to drink

A

> 50-100 units per week >10 years

43
Q

how is fatty liver disease diagnosed?

A

ultrasound scan or other imaging since only 50% have abnormal liver function disease

44
Q

critical determinate of fatty liver disease?

A

Non-alcoholic steatohepatitis or simple steatosis

45
Q

significant fibrosis can only be determined by

A

liver biopsy or fibroscan

46
Q

do abnormal liver tests tell if a patient has NASH or simple steatosis?

A

no

47
Q

what is a fibroscan?

A

determines liver stiffness and CAP score
measures how wobbly the liver is
CAP score measures fat content

48
Q

what hepatitis types cause chronic viral hepatitis?

A

B and C

49
Q

what do hepatitis b and c cause?

A

chronic inflammation of the liver and cirrhosis

50
Q

treatment for primary biliary cholangitis

A

usrodeoxcholic acid
severe - obetocholic acid

51
Q

primary sclerosing cholangitis

A

causes stricturing of small and large bile ducts

52
Q

complications of cirrhosis

A

portal hypertension - ascites, varices, hepatorenal syndrome, hepatic encephalopathy
immune paresis

53
Q

hepatitis D only affects ____

A

people with hepatitis B

54
Q

hepatorenal syndrome

A

renal failure that occurs in patients with severe liver disease in the absence of any pathological cause for kidney failure

55
Q

what reverses hepatorenal syndrome?

A

liver transplant

56
Q

acute kidney injury

A

acute significant reduction in the glomerular filtration rate

57
Q

most practical biomarker of renal function

A

serum creatinine
influenced by bodyweight, race, age, gender

58
Q

use of serum creatinine in patients with cirrhosis is affected by

A

less formation of creatinine in muscles
increased renal tubular secretion of creatinine
interference with assays for sCr by elevated bilirubin

measurement overestimates gfr

59
Q

diagnostic criteria for Acute kidney injury

A

> 50% inc in sCR from known baseline
increase in sCr >2 micromol within 48 hrs

60
Q

main features of hepatorenal syndrome

A

functional renal failure caused by intra renal vasoconstriction
circulatory dysfunction caused by vasodilatation leading to effective hypovolemia

61
Q

factors involved in the pathogenesis of HRS

A

hemodynamic factors
impaired cardiac ouput
activation of sympathetic nervous system
POSSIBLY inc formation of vasoactive mediators

62
Q

does a low CO increase risk of HRS?

A

yes

63
Q

how does activation of sympathetic nervous system affect renal blood flow in HRS

A

a small decrease in blood pressure reduces blood flow by a lot more
renal vasculature more sensitised to changes in BP and CO

64
Q

what do vasoactive mediators do?

A

cause mesangial cell contraction
reduced SA of glomerulus
low GFR

65
Q

management of HRS

A

treat underlying cause
support renal function - hemofiltration or dialysis
vasoconstrictors to optimise BP
liver transplant
paracentesis for tense ascites

66
Q

drug example for HRS

A

terlipressin

Clinical Physiology (11 decks)

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