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Hepatic Failure (NAFLD) Flashcards

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1
Q

T/F: LFTs are indicators of liver function.

A
  • false

* indicators of hepatocellular injury

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2
Q

Which of the transaminases is liver specific?

A
  • ALT
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3
Q

Total bilirubin can be measured in what 2 ways?

A
  • (direct + indirect)

- (conjugated + unconjugated + delta)

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4
Q

What lab value is a good marker for chronic liver disease?

A
  • albumin
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5
Q

Which of the coagulation pathway is a better predictor of liver disease?

A
  • aPTT

INR can be elevated d/t malnutrition

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6
Q

All clotting factors except for ____ are made in the liver.

A

Factor VIII

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7
Q

NALFD has a strong association with these 2 factors.

A
  • obesity

- insulin resistance

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8
Q

The pathophysiology of NALFD is based around what dysfunction?

A
  • triglyceride disregulation

* precursors of TG are hepatotoxic

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9
Q

The fatty liver index (FLI) is composed of these 3 variables.

A
  • triglycerides
  • BMI
  • waist circumference
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10
Q

What are the FLI cut offs and what risks correspond to each?

A
  • <30 = low
  • 30-60 = indeterminate
  • > 60 = high*

*fatty liver ruled in

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11
Q

What are some signs of liver dysfunction/failure in later NAFLD? (3 listed)

A
  • angiomas
  • portal HTN
  • jaundice
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12
Q

What is the first imaging modality you would get for NALFD?

A
  • ultrasound
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13
Q

What is the gold standard diagnostic study for NALFD?

A
  • liver biopsy

* see fibrosis developed

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14
Q

This new type of diagnostic study for NALFD uses ultrasound and low frequency waves.

A

transient elastography

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15
Q

What is NASH and what causes it?

A
  • nonalcoholic hepatosteatosis

- result of progression of NALFD when tissue death and necrosis occurs (25% of patients)

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16
Q

To get a NAFLD Fibrosis score it requires these 4 variables.

Study These Flashcards
A
  • AST
  • ALT
  • platelet count
  • albumin
17
Q

What NALFD scores do we need to remember? What fibrosis stages do they correlate with?

Study These Flashcards
A
  • < -1.455 = F0-F2

- > 0.675 = F3-F4

18
Q

What do the 4 fibrosis stages correspond with?

Study These Flashcards
A
  • F0 = no fibrosis
  • F1 = mild
  • F2 = moderate
  • F3 = severe
  • F4 = cirrhosis
19
Q

What are the Fibrosis-4 (FIB-4) score criteria and what fibrosis stage do they correlate with?

Study These Flashcards
A
  • <1.54 = 0-1
  • 1.54-3.25 = 2-3
  • > 3.25 = 4

*fibrosis stage

20
Q

Weight loss of ____ % can improve steatosis.

Study These Flashcards
A

3-5%

*10% if steatohepatitis

21
Q

What lifestyle modifications may help in the treatment of NAFLD? (5 listed)

Study These Flashcards
A
  • low carb diet
  • weight loss
  • exercise
  • coffee
  • vitamin E/C
22
Q

Why is metformin not recommended for NAFLD?

Study These Flashcards
A
  • no histological improvement
23
Q

What is one main side effect of pioglitazone?

24
Q

What are the 3 drug therapies that have been used for treatment of NAFLD?

Study These Flashcards
A
  • metformin
  • pioglitazone
  • statins

*none first line

25
Large studies have shown this adverse side effect with bariatric surgery for NAFLD.
- increased fibrosis
26
When NAFLD has progressed to ELSD what is the only treatment option?
- liver transplant
27
What are the 2 markers of hepatic failure?
- Hepatic encephalopathy | - Elevated INR > 1.5
28
What is the typical toxin that causes hepatic encephalopathy?
- ammonia
29
T/F: Diagnosis of hepatic encephalopathy is clinical.
- True
30
How do you treat intercranial hypertension?
- mannitol/hypertonic saline
31
What is the most common cause of hepatic failure?
- acetaminophen (tylenol)
32
Tylenol overdose is reversible if treatment is started how soon?
- first 24 hours | * no damage if started <8 hours
33
At what part of tylenol metabolism does liver damage occur?
- damage occurs when glucuronide pathway is overwhelmed | * NAPBQI will accumulate = toxic*
34
What is the reversal agent for acetaminophen overdose and how does it work?
- N-acetylcysteine (NAC) | - works my replacing glutathione to break down NAPBQI
35
Activated charcoal can also be given with NAC for tylenol overdose if it is within how many hours of ingestion?
- < 2 hr from ingestion
36
What is the first sign of liver damage from tylenol overdose?
- elevated AST
37
What are the 4 potential causes of ischemic hepatitis?
- septic shock - cardiogenic shock - hepatic vein thrombosis - cocaine
38
What does the MELD scoring provide? What 2 values do we have to remember?
- prediction of 30 day mortality for ESLD <8 - 5.7% >20 - 50%
39
The MELD scoring system uses these 4 variables.
- bilirubin - creatinine - INR - Na+

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