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957 Block 2 > 4. Liver Injury > Flashcards

4. Liver Injury Flashcards

1
Q

What is the location of the liver?

A

right upper quadrant

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2
Q

The liver receives __% of cardiac output.

A

25

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3
Q

What are the major blood vessels of the liver?

A

portal vein

hepatic artery

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4
Q

What are the 3 main functions of the liver?

A
  • energy metabolism
  • protein production
  • detoxification
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5
Q

What hepatic processes serve as energy metabolism?

A
  • gluconeogeneisis/ glycogenolysis

- cholesterol synthesis

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6
Q

What proteins are produced in the liver?

A
  • albumin

- coagulation factors

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7
Q

What processes are used for detoxification by the liver?

A
  • drug metabolism (phase I and II)
  • ammonia, urea cycle
  • synthesis of glutathione
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8
Q

What is the Phase I reaction?

A
  • oxidation
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9
Q

What is the Phase II reaction?

A

covalent attachment of the drug to a water-soluble carrier molecule

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10
Q

Acute liver failure occurs within ____ to _____.

A

days

weeks

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11
Q

What are some lab values that indicate acute liver failure?

A
  • elevated liver enzymes
  • high bilirubin
  • high INR (thin blood)
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12
Q

What is the diagnostic triad for acute liver failure?

A
  • < 26 weeks
  • INR greater than or equal to 1.5
  • encephalopathy
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13
Q

What are the signs and symptoms of chronic liver failure?

A
  • normal or slightly elevated AST, ALT

- minimal/ no symptoms until jaundice

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14
Q

Chronic liver failure is sometimes reversible. (T/F)

A

True

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15
Q

What is centrolobular necrosis?

A

direct or metabolite related hepatotoxicity

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16
Q

In centrolobular necrosis, damage spreads from _____ lobe and in an _______ direction.

A

middle

outward

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17
Q

What is a very common cause of centrolobular necrosis?

A

acetaminophen overdose

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18
Q

What is steatohepatitis?

A

an accumulation of fatty acids in hepatocytes

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19
Q

What is a common cause of steatohepatitis?

A

alcohol

20
Q

What are the 2 subcategories of steatohepatitis?

A
  • Alcoholic fatty liver diseae

- Non-alcoholic steatohepatitis (NASH)

21
Q

What are some causes of NASH?

A
  • obesity

- drug induced (tetracycline, valproic acid)

22
Q

What is the cause of generalized hepatocellular necrosis?

A

autoimmune

23
Q

Generalized hepatocellular necrosis has a similar process to viral hepatitis. (T/F)

A

True

24
Q

What is cholestatic injury?

A

slowed bile flow through bile ducts

25
Q

What are some lab values that indicate cholestatic injury?

A

high bilirubin and high alkaline phosphate are seen first, followed by increased liver enzymes

26
Q

What are some main assessments that you must make about the patient in order to appropriately treat condition?

A
  • medication/medical history
  • time frame
  • occupation
  • nutritional status
27
Q

Diagnosis of liver injury is a diagnosis of _______.

A

exclusion

28
Q

What are risk factors for liver injury?

A
  • female
  • alcohol use
  • malnutrition
  • genetic
29
Q

What could happen to a patient with inadequately treated liver injury?

A
  • chronic liver disease
  • fulminant hepatic failure
  • death
30
Q

What is the main treatment plan for liver injury?

A
  • remove offending agent
  • antidote
  • dialysis
  • supportive care
  • liver transplant
31
Q

What is a toxic acetaminophen dose for an adult?

A

7.5 - 10 g

32
Q

What is a toxic acetaminophen dose for a child?

A

150 - 200 mg/kg

33
Q

Acetaminophen is mainly metabolized via _________.

A

glucuronidation

34
Q

A person overdoses on acetaminophen when ______ is depleted.

A

glutathione

35
Q

The Rumack-Matthew nomogram can be used __ hours after ingestion.

A

4

36
Q

The Rumack-Matthew nomogram is only used for long-term chronic exposure to acetaminophen. (T/F)

A

False: only for acute exposure

37
Q

When is activated charcoal an appropriate treatment option for acetaminophen overdose?

A

within 4 hours of ingestion

38
Q

When is activated charcoal NOT an appropriate treatment option for acetaminophen overdose?

A
  • N/V prior to administration of charcoal

- lack of airway protection/ or altered mental status

39
Q

What is the antidote to acetaminophen overdose?

A

N-acetylcysteine

40
Q

N-acetylcystein is nearly 100% hepatoprotective if given ≥__ hours after ingestion.

A

8

41
Q

What is the oral formulation of N-acetylcystein?

A

Mucomyst

42
Q

What is the IV formulation of N-acetylcystein?

A

Acetadote

43
Q

What is the loading dose for Mucomyst?

A

140 mg/kg

44
Q

What is the maintenance dose for Mucomyst?

A

70 mg/kg q4h x 17 doses

45
Q

What is the loading dose of Acetadote?

A

150 mg/kg

46
Q

What is the 2nd dose of Acetadote?

A

50 mg/kg

47
Q

What is the 3rd dose of Acetadote?

A

100 mg/kg

957 Block 2 (14 decks)

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