Lecture 17: Liver Disease

Question 1

largest gland in body is:

Answer 1

the liver

Question 2

hepatocytes form ___% of liver mass, and are crucial for:

Answer 2

80; metabolism of aa and ammonia, detox, biochem oxidation rxns

Question 3

____% of liver cells need to be injured before signs of dysfunction occurs

Answer 3

80-90

Question 4

liver receives blood from ___ and ___

Answer 4

hepatic artery (bring in oxygen supply); hepatic portal vein (venous blood drains from GI tract to liver for nutr processing/storage)

Question 5

blood leaves liver from:

Answer 5

hepatic vein (back to heart to reoxygenate)

Question 6

yellow/green fluid composed of cholesterol, bile acid, bilirubin, water, K, Na, bicarbonate, copper, other metals

Answer 6

bile

Question 7

bile is produced in ___ stored in ____ and is an ___ agent

Answer 7

liver; gallbladder; emulsifying

Question 8

acute liver failure caused by __________

Answer 8

acute hepatitis, shock liver, fulminant liver disease, acute on chronic liver failure

Question 9

what is fulminant liver disease?

Answer 9

someone healthy develops liver failure within 2-8 weeks of liver insult

Question 10

chronic liver failure usually driven by ____ which causes ____

Answer 10

inflammation; fatty liver/steatosis, fibrosis, cirrhosis, hepatocellular carcinoma

Question 11

what is diff between compensated and decompensated liver disease?

Answer 11

comp: pt has cirrhosis but doesn’t show external s/s of liver disease
decomp: person has s/s related to their liver disease

Question 12

categories of causes of liver disease?

Answer 12

toxins, metabolic, infections, immune-mediated, other

Question 13

obesity can cause NALFD which is:

Answer 13

non-alcoholic fatty liver disease

Question 14

primary causes of liver diseases:

Answer 14

alcohol, obesity, viral (hep a b c)

Question 15

clinical manifestations of liver disease:

Answer 15

jaundice, bruising, muscle wasting, altered hair distribution, encephalopathy, cirrhosis, hepatorenal syndrome, tea coloured urine, esophogeal varices, spider angloma, etc.

Question 16

liver function tests/liver panel includes these enzymes, these proteins, these clotting studies, ammonia, and bilirubin

Answer 16

enzymes: ALP, ALT, AST, GGT, LDH; proteins: albumin, total protein, clotting: PTT, INR

Question 17

is total (unconjugated) or direct (conjugated) bilirubin more often measured?

Answer 17

total

Question 18

bilirubin is breakdown product of ____

Answer 18

heme

Question 19

jaundice of eyes called:

Answer 19

icteric sclerae

Question 20

prob of itchiness (pruritis)?

Answer 20

might create open wounds, probs with wound healing and blood clotting

Question 21

why jaundice happen?

Answer 21

^ bilirubin cause ^ RBC destruction which causes ^ bilirubin uptake but decrease liver fxn which ends up in bile duct obstruction

Question 22

primary symptoms/complications of portal hypertension (blood flow forced backward, veins enlarge):

Answer 22

ascites, esophageal varices, hepatic encephalopathy

Question 23

accumulation of fluid in peritoneal cavity where fluid leaks from ___ to abdominal space, leading to decrease in _____

Answer 23

capillaries; albumin

Question 24

how to remove ascites?

Answer 24

abdominal paricentesis (there will be protein in the fluid)

Question 25

low pressure veins in esophagus and upper stomach that become distended cuz ^ pressure due to portal HTN

Answer 25

esophageal varices

Question 26

if non-bleeding esophageal varices, can use _____ tubes; if actively bleeding, hold EN for ____ h post-banding

Answer 26

nasoenteric; 48-72

Question 27

critically ill pt should use ____ tube

Answer 27

sengstaken - blakemore

Question 28

pathogenesis of hepatic encephalopathy?

Answer 28

ammonia bypasses liver metabolism and accumulates, metabolized at extrahepatic sites to glutamine which ^ oxidative stress, crossing blood brain barrier and accumulate in brain (toxic)

Question 29

is plasma ammonia level good indicator of NH3 levels and HE?

Answer 29

nope

Question 30

primary treatment for HE:

Answer 30

lactulose (potent and effective laxative , osmotic diarrhea), antibiotics (v colonic concentration of bacteria producing NH3)

Question 31

3 major cause malnutrition in cirrhosis?

Answer 31

1) factors resulting in decreased po intake, 2) physio aberrations resulting impaired digestion/absorption 3) impaired nutr metabolism

Question 32

anorexia is caused by ___ deficiency

Answer 32

zinc

Question 33

etiology of sarcopenia/muscle wasting in cirrhosis:

Answer 33

anabolic resistance, accelerated lipolysis, accelerated aa oxidation, increased autophagy mediated proteolysis in muscle, hyperammonemia

Question 34

goals of Nutrition therapy for sarcopenia?

Answer 34

promote/maintain N balance, promote liver regeneration, prevent metabolic abnormality exacerbations, treat malnutrition

Question 35

strategies to improve PO intake in liver disease:

Answer 35

small frequent meals, nutr dense foods, ONS, EN may be warranted

Question 36

should protein be restricted in HE?

Answer 36

no because ^ skel muscle breakdown releases more N containing AA that can further ^ NH3 production

Question 37

protein recommendations for HE:

Answer 37

1-1.5 g/kg/d *not below 0.8

Question 38

altered aa metabolism in liver failure can result in ^ circ levels of ____ amino acids and v in plasma ____ amino acids

Answer 38

aromatic; branched chain

Question 39

^ aaa can worsen HE as cross blood brain barrier cuz act as _____

Answer 39

false neurotransmitters

Question 40

benefits of BCAA?

Answer 40

anabolic

Question 41

alcoholic liver disease is spectrum of these 3 disorders:

Answer 41

fatty liver, hepatitis, cirrhosis

Question 42

hepatotoxic alcohol threshold where ALD likely develop:

Answer 42

men 4 drinks a day, women 2 drinks a day

Question 43

vit/min deficiencies in alcoholism:

Answer 43

folic acid, thiamine, vit e, niacin, vit c, d, k, a, zn, fe, ca, k, mg

Question 44

essential coenzyme in CHO metabolism

Answer 44

thiamine

Question 45

thiamin deficiency causes:

Answer 45

wernicke's encephalopathy (hypothermia, confusion, ataxia, ocular probs), korsakoff's syndrome (memory probs)

Question 46

hepatic manifestation of metabolic syndrome/insulin resistance

Answer 46

NAFLD

Question 47

NAFLD may progress to ___ cuz of fat accumulation associated with liver cell inflamm and scar

Answer 47

NASH (non alcoholic steatohepatitis)

Question 48

risk factors for developing NASH:

Answer 48

adipose tissue inflamm, gut microbiota, oxidative stress, hepatocyte apoptosis, hepatic inflamm

Question 49

nutr consideration for NAFLD?

Answer 49

diet/physical activity, 10% wt loss, supplement vit E

Question 50

liver disease pt have high ___ use

Answer 50

complementary / alternative medicine