Flashcards in Treatment of Liver disease Deck (23):
The treatment for Pruritis is:
Anion Exchange Resins e.g. colestyramine, colestipol
Councelling, Antihistamines, Ursodeoxycholic acid, Topical therapies, rifampicin and opioid antagonists
How do Anion Exchange Resins work?
They bind the bile acids and prevent reabsorption from the gut into the blood. The side effects are GI (constipation, diarrhoea etc) and fat and vitamin malabsorption.
The other treatment of pruritis is Councelling:
Talk about the possible side effects to increase adherance
Take interacting drugs 1 hour before or 4 hours after Colestyramine,
Benefits may take up to one week to become apparent
Sedating properties may be useful if pruritis affects sleep
Ursodeoxycholic acid used to treat what type of liver disease, and is the product of what:
Used to treat Cholestatic disease, and is the product of bile salt bacterial metabolism.
Rifampicin is an:
Antibiotic used here to inhibit hepatocyte uptake of bile salts to reduce reabsorption rather than the antiobiotic properties.
Opioid antagonists are used because:
Itching is thought to be due to increased endogenous opiate tone.
The topical therapies are
Calamine lotion, menthol aqueous cream but evidence is less clear
The treatment of Ascites are aimed to
mobilise intra-abdominal fluid
What are the simple measures to treat Ascites
Reduce sodium intake
Moderate to severe Ascites require what type of treatment:
Diuresis (increased urine production), or paracentisis: suck fluid out using a syringe and needle
What are the possible Diuretic treatment:
Spironolactone is the 1st line treatment. It works by blocking the reabsorption in the kidney tubules
The dose ranges between 50-400mg daily, and should be titrated slowly
If severe, Furosemide may be added
Care should be taken to avoid excessive diuresis
What are the facts about Paracentisis?
It is used in refractory ascites (don't respond to other treatment) and is combined with albumin administration. Repeated every 2-4 weeks
What is the disadvantage about Paracentisis?
It does not affect the mechanism responsible for fluid accumulation
What is TIPS?
Transjugular intraheatic portosystemic shunt. Putting a stent into the shunt between the hepatic portal vein and systemic circulation
What are the symptoms of Enceohalopathy?
Lack of awareness, altered mental state, disorientation, coma
What are the causes of Encephalopathy?
Complex: Portosystemic shunting (a bypass of the liver by the systemi circulation), metabolic dysfuction, alteration of the BBB.
What precipitates the causes of Encephalopathy?
GI bleeding, SPB (spontaneous bacterial peritontitis) which occurs in people with portal hypertension, contipation and drugs
*these should be removed if present
What are the treatment options for Encephalopathy?
The condition is reversible,
treatment includes LACTULOSE which acidifies colonic contents, leading to ionisation of nitrogenous products and therefore reduction in absorption
and ANTIBIOTICS like Metronidazole which reduces ammonia production by the GI bacteria
What are the treatment for Clotting abnormalities?
IV phytomenadione (vit K) 10mg for 3 days. This is not significant in patients with significant disease.
Patients should also avoid NSAIDs, aspirin and anticoagulants.
The treatment of Varices which is the shunting of the portal blood to the systemic circulation to try to reduce portal hypertension, where pre-existing vessels dilate and there is active angiogenesis (new vessels formation):
The initial treatment is to stop immediate bleeding, treat hypovolaemic shock and the aim is to prevent recurrent bleeding.
What is the immediate treatment?
Terlipressin which is a vasopressin analogue and a systemic vasoconstrictor infused for 2-5 days.