Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Pharmacy Year 2 Semester 2 > Liver disease > Flashcards

Liver disease Flashcards

(61 cards)

Start Studying
1
Q

What are the liver’s main functions?

A

Largest single organ

Only organ to have 2 blood supplies
Arterial blood – 20% Hepatic artery
Venous blood – 80% Portal vein

Responsible for numerous functions
Storage - glycogen, fat soluble vitamins
Synthesis - proteins - albumin, clotting factors
Immune system – T cell proliferation, acute phase protein production
Clearance and metabolism etc- drugs, cholesterol (via liver enzymes)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the tests to identify liver disease?

A 
Large number of tests and questions
Tests related to the functions of the liver (to detect malfunction) and questions to identify possible cause
Example questions
Recent travel? = infections e.g. Hep A
Tattoos? = Hep B
Blood transfusions? = Hep B, C
Alcohol consumption? = chronic disease (cirrhosis)
Social History? = IVDA, poor hygiene
Medications? = drug induced
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Recent travel?

A

Infections e.g. HepA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Tattoos?

A

HepB

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Blood transfusions?

A

HepB, C

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Alcohol consumption?

A

Chronic disease - liver cirrhosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

social history?

A

IVDA - IV drug abuse, poor hygiene

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Medications?

A

Drug induced

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

LFTs

A

Tests are fairly non specific
Can have large rises in enzymes with minimal damage
Liver function tests (LFTs)
-Bilirubin (breakdown product of RBC) – conjugated in liver then excreted in bile
-GGT (gamma-glutamyl transferase) – -
-ALT (alanine aminotransferase), AST (aspartate aminotransferase) – transaminase enzymes
-Alkaline phosphatase
-Albumin
-Prothrombin time

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

When is GGT raised?

A

Recent alcohol consumption

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

ALT and AST increase means?

A

Hepatocyte injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Alkaline phosphatase q

A

not specific to liver

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Albumin is a sign of?

A

Liver’s synthetic function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Prothrombin time?

A

Clotthing factors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

LFT results typical for hepatocellular damage

i.e. damage inside the liver

A

↑ ALT
↑ AST
↑ gamma GT
↑ Total bilirubin (later in presentation)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

LFT results typical for Cholestatic picture (blockage of bile dict etc)

A

↑ Conjugated bilirubin
↑ Alk phos
↑ Total cholesterol
Pruritis common (severe itching of skin)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Acute liver disease

A

Usually self limiting
Inflammation or damage to liver cell (hepatocyte)
Inflammation of hepatocyte = hepatitis
Classified on duration – not exceeding 6/12
Majority of cases caused by
Drugs (paracetamol most common)
Acute viral hepatitis – A & B (Europe), E (India)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Symptoms of drug-induced liver disease

A

Wide range of symptoms from
Reversible alteration in LFTs
Fatal acute hepatic necrosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Types of reaction (drug-induced liver disease)

A

Type A

Type B

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Type A reaction

A 
Type A - predictable reactions
Dose dependent
Affect most patients who take sufficient amounts of the drug
Examples - paracetamol, methotrexate
Latent period – hours to weeks
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Type B reaction

A 
Type B - unpredictable reactions
Less frequent- ~1% of patients
Dose independent
Latent period of weeks to months
Examples - isoniazid, chlorpromazine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Name two types of acute liver disease

A
  • acute hepatitis

- acute liver failure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Describe acute hepatitis

A

Present with jaundice
Spontaneous recovery is the norm
Supportive therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Describe acute liver failure

A

can be severe, affecting whole liver
can progress to hepatic failure associated with high mortality
Alternatively become chronic liver disease
? Transplantation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
how long does chronic Liver Disease go on for?
Liver disease lasting > 6 months
26
Common causes of Chronic liver disease? | Other causes?
Common causes Alcohol Chronic viral hepatitis (Hepatitis C) Other causes Primary biliary cirrhosis Auto-immune hepatitis - can be drug related Cancer
27
Signs and symptoms of chronic liver disease
Patient can present with vague unspecific symptoms - -fatigue - general malaise - fever - nausea and vomiting Abdominal pain - particularly upper right quadrant Pruritis (itch) - most common in obstructive disease (bile salts) Jaundice - yellow skin, pale stools, dark urine ( Bilirubin > 50umol/L)
28
Common signs and symptoms of chronic liver disease
Common - Spider naevi - Gynaecomastia - Splenomegaly - Oedema - Finger clubbing - Liver palms - Xanthelasmas
29
What is spider naevi?
a cluster of minute red blood vessels visible under the skin, occurring typically during pregnancy or as a symptom of certain diseases (e.g. cirrhosis or acne rosacea).
30
Define gynaecomastia
Enlargement of breasts in men
31
What is splenomegaly?
Abnormal enlargment of the spleen
32
Define xanthelasma
demarcated yellowish deposit of fat underneath the skin, usually on or around the eyelids. While they are neither harmful nor painful, these minor growths may be disfiguring and can be removed.
33
End stage symptoms of chronic liver disease
``` End Stage Ascites Hepatic flap Dilated abdominal blood vessels Neurological changes Oesophageal varices ```
34
Define ascites
the accumulation of fluid in the peritoneal cavity, causing abdominal swelling.
35
What is hepatic flap?
Asterixis (also called the flapping tremor, or liver flap) is a tremor of the hand when the wrist is extended, sometimes said to resemble a bird flapping its wings
36
Define oesophageal varices
extremely dilated sub-mucosal veins in the lower third of the esophagus. Medical emergency due to large blood loss Aim to stop bleeding and replace lost blood Colloids, packed red cells Banding, balloon tamponade, sclerotherapy
37
What is the most common cause of liver disease in the UK?
Alcoholic liver disease
38
Alcohol excess can lead to what?
Alcohol excess→Steatosis→fibrosis→cirrohosis Alcohol excess→fibrosis→cirohosis Alcohol excess→Hepatitis→Cirrohosis
39
Normal alcohol excess blood changes?
Elevated GGT
40
Steatosis definition and blood changes
- infiltration of liver cells with fat, associated with disturbance of the metabolism - Elevated GGT +/- AST
41
Cirrhosis definition and blood changes
a chronic disease of the liver marked by degeneration of cells, inflammation, and fibrous thickening of tissue. High PT low albumin
42
Hepatitis blood changes
elevated bilirubin
43
Describe Pruritis
``` Patient jaundiced Itching – may see scratch marks More severe in cholestasis Common and distressing Possibly due to bile salts in skin Treatment depends on cause Bile stones – surgical or other removal Medical therapy if cause unknown ```
44
Define Cholestasis
defined as a decrease in bile flow due to impaired secretion by hepatocytes or to obstruction of bile flow through intra-or extrahepatic bile ducts.
45
Pruritis treatment if cause is bile stones
surgical or other removal
46
Pruritis treatment generally
Tx depends on cause Bile stones – surgical or other removal Anion exchange resins Colestyramine sachets (4g od or bd) Bind bile acids in the gut Problems with fat soluble vitamins e.g. Vit K Antihistamines Sedating = care needed may be useful nocte Non sedating = better e.g. Desloratidine 5mg OD Topical – Calamine, Menthol 2% in aqueous cream Others e.g. naltrexone, IV ondansetron, rifampicin, urseodeoxycholic acid
47
Ascites cause
Cause mainly unknown but Portal hypertension Activation of Renin Angiotensin System Decreased oncotic pressure – low albumin
48
Ascites treatment
``` Spironolactone => 100–600mg OD (aldosterone antagonist) Furosemide => 40-160mg OD Metolazone in unresponsive cases (care) Aim to lose ~ 0.5 - 1kg body weight/day Others Low sodium diet ```
49
Analgesics for ascites
Analgesics for ascitic pain Paracetamol - caution (max 2g a day) Tramadol usually okay NSAIDs / Antiplatelets = risk of bleeding Opioids = decreased clearance. Extra care needed may cause respiratory depression
50
Ascities loss aim
0.5-1kg body weight daily | low sodium diet may help
51
features of hepatic encephalopathy | What is it?
the occurrence of confusion, altered level of consciousness, and coma as a result of liver failure. Altered mental state Asterixis (liver flap) Fetor hepaticus (sweet, pungent breath)
52
Cause of hepatic encephalopathy
Thought to be caused by Accumulation of nitrogenous and other toxins Worsened by GI bleeds, constipation, sedative use (opiates), high protein diet
53
Treatment of hepatic encephalopathy
Low protein diet Lactulose – 20-30ml tds po/pr, enough for 2-3 movements/day Neomycin – 2-4g/ day (peripheral neuropathy) Rifaxamin- 400mg tds/bd (good evidence) (antibiotic) Metronidazole – 400-800mg in divided doses Enemas if can’t swallow
54
Oesophageal varices drug treatment
Pharmacological – constrict blood flow Terlipressin IV= 1-2mg bolus, then 4-6 hourly Octreotide = 50mcg/hour for 48hrs or more Somatostatin or Vasopressin (2nd line) Treatment of portal hypertension- propranolol 40mg bd or tds/ carvedilol 6.25mg
55
Alcohol withdrawal vitamin replacement
Chlordiazepoxide reducing regimen +PRN Vitamin B co strong + thiamine (vitB1) orally – prevent Wernicke’s encephalopathy (thiamine deficiency) Can use IV Pabrinex if NBM – care needed in administration Vitamin K deficiency - use water soluble prep- menandiol 10mg od
56
Treatment of Hepatitis A | Vaccine?
Hepatitis A – treatment supportive, no therapy to eradicate | Vaccination recommended for travellers
57
Treatment of hepatitis B
Hepatitis B – Chronic infection tx with Entecavir or tenofovir (antivirals) with Interferon alfa 2a (boosts immune function) Vaccination recommended for healthcare workers
58
Hepatitis C | Treatment
Hepatitis C – world wide health problem Can lead to chronic hepatitis and cirrhosis and cancer Tx includes Ribavirin combined with Interferon alfa 2b In both chronic hep B & C, pegylated interferon alfa 2b preferred. Less frequent administration due to longer half-life NICE guidance for Hep B & C treatments
59
Hepatitis D
Hepatitis D – need Hep B to cause infection | No specific Tx
60
Hepatitis E
Hepatitis E – self limiting infection that doesn’t cause chronic liver disease
61
Role of pharmacist in Liver disease
Ensure regular monitoring of LFTs Counsel patients on side effects of treatments Being aware of drugs commonly implicated in liver disease (inc herbal) Taking full drug history in suspected cases Advise on supportive therapy and ensure appropriately prescribed

Pharmacy Year 2 Semester 2 (33 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions