What is a common sign of liver disease?
What liver disease is associated with obesity?
non-alcoholic fatty liver disease, or hepatic steatosis
What are some causes of liver disease?
What is cirrhosis?
Small shrunken liver which cannot regenerate
What are three major factors of cirrhosis?
Reduced liver blood flow
Reduced metabolic function
Reduced plasma proteins
If an alcoholic patient presents with lots of fractured ribs, what could have caused this?
Alcoholism - lots of falling over, bumps and bruises
What is portal hypertension?
High blood pressure in the portal venous system, caused by cirrhosis
Where do varices appear in cirrhosis?
What is a major complication of these varices?
What is a sign of liver disease in which a patient becomes confused and disorientated?
What is a sign of portal hypertension seen at the umbilicus?
What happens to some of the blood in cirrhosis?
Portal system bypassed
"shunting" of blood past the liver, metabolism doesn't occur so more of a drug needs to be administered to see the same effect
In cirrhosis, the liver has (increased/reduced) metabolic capacity.
High portal pressure and low albumin causes ___ in the abdomen.
If the oral dose of a drug is greater than the IV dose, what organ is important in its metabolism?
Which drug is administered sublingually to treat angina?
Why is it administered this way?
Sublingual administration bypasses the liver
The liver has a limit of metabolism - small doses of a drug can be metabolised but increasing the rate of administration may suddenly cause the plasma concentration to increase. What drug is this prominently seen in?
Which plasma protein is lowered in liver disease?
marker of liver disease
can carry less protein in blood, leading to ascites
Low albumin levels causes a low ___ volume.
Why may plasma volume decrease, prompting the kidneys to secrete renin?
Low albumin in liver disease
Which system produces aldosterone as a response to low albumin (low plasma volume)?
Which product of the RAAS system cannot be metabolised by diseased livers?
What name is given to accumulation of aldosterone in patients with liver disease?
Why do people with liver disease develop gynaecomastia?
Liver cannot metabolise hormones like oestrogen and endothelin
In liver disease, hormones aren't metabolised and go on to act on the kidneys. What are some consequences of this?
Potassium loss - HYPOKALAEMIA
Sodium retention - HYPERNATREMIA & WATER RETENTION
Aldosterone also causes ___ in the kidney.
What condition does this cause?
The failure of the liver to metabolise drugs, which then travel to the kidneys, leads to what?
Reduced renal clearance
Reduced renal function
What signs are seen in patients with reduced hepatic and renal function?
Spider naevi, gynaecomastia (lots of oestrogen)
Congestive heart failure
Which class of drug would further impair renal function by inhibiting prostaglandin production?
What is a major GI side-effect of NSAIDs?
Would you give an NSAID as analgesia to someone suffering liver disease?