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Clinical Physiology > Intestinal Failure and Liver Disease > Flashcards

Intestinal Failure and Liver Disease Flashcards

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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
commonest causes of abnormal liver function tests?
fatty liver disease and alcohol
26
higher ast/alt ratio suggests
alcohol or significant fibrosis
27
treatable causes of liver disease
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
alanine transaminase and aspartate transaminase catalyse ______
aspartane and alanine
29
unconjugated fraction of bilirubin binds to
serum albumin
30
low serum albumin
infection, renal loss - nephrotic syndrome , impaired synthesis - severe liver disease, severe malnutrition
31
very high transaminases signify
liver cell injury with release of enzymes into circulation e.g., acute viral hepatitis
32
very very high transaminases
paracetamol overdose, ischemic hepatitis
33
moderately elevated ALT and AST
fatty liver, cholangitis
34
alkaline phosphatase is found in
liver, bone, biliary, placenta, intestine
35
marked increase in alkaline phosphatase suggests
biliary obstruction, primary sclerosing cholangitis, primary biliary cholangitis
36
what should you always check with inc alk phos
corresponding increase in gamma GT if not measure alk phos isoenzymes
37
very high gamma GT indicates
biliary obstruction, cholestasis, alcohol
38
what is the fib4 score
indirect biomarker of liver fibrosis calculated from alt, ast, platelet count and age
39
causes of chronic liver disease
alcohol chronic viral hepatitis B,C fatty liver disease autoimmune liver disease other - iron overload, biliary disease, inherited disease
40
chronic inflammation leads to ______
cell death, regeneration, fibrosis (scar tissue)
41
alcohol is metabolised to
acetaldehyde and fat
42
to develop alcohol related cirrhosis need to drink
>50-100 units per week >10 years
43
how is fatty liver disease diagnosed?
ultrasound scan or other imaging since only 50% have abnormal liver function disease
44
critical determinate of fatty liver disease?
Non-alcoholic steatohepatitis or simple steatosis
45
significant fibrosis can only be determined by
liver biopsy or fibroscan
46
do abnormal liver tests tell if a patient has NASH or simple steatosis?
no
47
what is a fibroscan?
determines liver stiffness and CAP score measures how wobbly the liver is CAP score measures fat content
48
what hepatitis types cause chronic viral hepatitis?
B and C
49
what do hepatitis b and c cause?
chronic inflammation of the liver and cirrhosis
50
treatment for primary biliary cholangitis
usrodeoxcholic acid severe - obetocholic acid
51
primary sclerosing cholangitis
causes stricturing of small and large bile ducts
52
complications of cirrhosis
portal hypertension - ascites, varices, hepatorenal syndrome, hepatic encephalopathy immune paresis
53
hepatitis D only affects ____
people with hepatitis B
54
hepatorenal syndrome
renal failure that occurs in patients with severe liver disease in the absence of any pathological cause for kidney failure
55
what reverses hepatorenal syndrome?
liver transplant
56
acute kidney injury
acute significant reduction in the glomerular filtration rate
57
most practical biomarker of renal function
serum creatinine influenced by bodyweight, race, age, gender
58
use of serum creatinine in patients with cirrhosis is affected by
less formation of creatinine in muscles increased renal tubular secretion of creatinine interference with assays for sCr by elevated bilirubin measurement overestimates gfr
59
diagnostic criteria for Acute kidney injury
>50% inc in sCR from known baseline increase in sCr >2 micromol within 48 hrs
60
main features of hepatorenal syndrome
functional renal failure caused by intra renal vasoconstriction circulatory dysfunction caused by vasodilatation leading to effective hypovolemia
61
factors involved in the pathogenesis of HRS
hemodynamic factors impaired cardiac ouput activation of sympathetic nervous system POSSIBLY inc formation of vasoactive mediators
62
does a low CO increase risk of HRS?
yes
63
how does activation of sympathetic nervous system affect renal blood flow in HRS
a small decrease in blood pressure reduces blood flow by a lot more renal vasculature more sensitised to changes in BP and CO
64
what do vasoactive mediators do?
cause mesangial cell contraction reduced SA of glomerulus low GFR
65
management of HRS
treat underlying cause support renal function - hemofiltration or dialysis vasoconstrictors to optimise BP liver transplant paracentesis for tense ascites
66
drug example for HRS
terlipressin

Clinical Physiology (11 decks)

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