Term
| What are the functions of the liver? |
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Definition
- Detox - alcohol, ammonia, nicotine, drugs, byproducts
- Metabolism - deamination, reduction, oxidation
- Synthesis/Metabolism of protein, fats, carbs
- Production and excretion of bile
- Synthesis of plasma proteins - Albumin, globulins, prothrombin, fibrinogen
- Regeneration of RBCs |
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Term
| How is a liver disease diagnosis made? |
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Definition
- High bilirubin - cholestasis
- low albumin
- Elevated AST/ALT - markers of cell damage
- Prothrombin time increase |
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Term
| What is the Child-Turcotte-Pugh score? |
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Definition
| A measure of cirrhosis and risk of bleeding - as cirrhosis progresses, risk of a bleed increases. |
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Term
| What are the physical findings of liver disease? |
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Definition
- Muscle wasting
- Hemorrhage in the skin
- Yellowing of the eyes
- Hepatomegaly w/ tenderness
- Confusion and depression |
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Term
| How is hyperbilirubinemia treated? |
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Definition
| Especially dangerous in newborns when bilirubin can cross BBB. Phenobarb increases excretion. Phototherapy converts to a non-toxic form. |
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Term
| What are risk factors for cirrhosis? |
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Definition
- Alcoholism - leading cause
- Drugs - TYLENOL, methotrexate, methyldopa, isoniazid
- Hepatitis C
- Obesity in NON alcoholic patients |
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Term
| What are the effects of cirrhosis? |
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Definition
- Ascites - Marker of severe progression. Can become infected.
- Varices - Mortality in 50%
- Hepatic Encephalopathy - buildup of intestinal toxins (ammonia)
- Coagulation - Vit K clotting factors reduced. Thrombocytopenia |
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Term
|
Definition
- Salt restriction - 2g/day
- Diuretics
- Paracentesis w/ albumin to prevent renal failure.
**Cefotaxime drug of choice for peritonitis |
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Term
| How are esophageal varices treated? |
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Definition
- Fluids
- RBC/plasma infusion
- Clotting factors - stop the bleeding
- Octreotide or Vasopressin to vaso constrict
- Short term antibiotic - Norfloxacin |
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Term
| How is hepatic encephalopathy treated? |
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Definition
Caused by ammonia - reduce! No protein!
- Lactulose - removes ammonia. Increases bowel movements
- Antibiotics - Flagyl/Neomycin short term due to ototoxicity. Xifaxin if Lactulose isn't working |
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Term
| How can complications be prevented in liver disease? |
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Definition
- Lower portal pressure - propranolol and nadolol
- NO ALCOHOL
- Milk thistle or SAMe |
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Term
|
Definition
From feces - contaminated food, healthcare workers, daycare, etc.
ACUTE and self-limiting. |
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Term
| What is the pathogenesis of Hep B? |
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Definition
Considered an STD, mainly from sexual contact.
Beginning: HBsAG. Getting better: anti-eAG |
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Term
| What 'introns' treat Hep B? |
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Definition
- Interferon alfa-2b/Intron SQ QD
- PegInterferon alfa-2a/Pegasys SQ QW
**AEs are limiting, not resistance. Fatigue and depression are terrible. Very very expensive. |
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Term
| What nucleoside analogues are used to treat Hep B? |
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Definition
- Lamivudine/Epivir - PO QD
- Entecavir/Baraclude
- Telbivudine/Tyzeka
- Emtricitabine/Emtriva - only for HIV combo
**Less expensive and safer, but develops resistance. |
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Term
| What drugs are nucleoTIDE analogues to treat Hep B? |
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Definition
- Adefovir/Hepsera - 10 mg po QD MAX b/c of kidney toxicity
- Tenofovir/Viread |
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Term
| What are the types of Hep C? |
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Definition
Acute can progress to chronic --> chronic progressive, which can become cirrhosis. A silent disease with no vaccine.
Main cause: IV drug use. |
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Term
| What are intron treatments for Hep C? |
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Definition
- Peginterferon alfa-2a (Pegasys) + ribavirin (Copegus)
- Peginterferon alfa2b (Pegintron) + ribavirin (Rebetol)
- Interferon alfa-2b (Intron) + ribavirin (rebetol)
**AE: Flu-like symptoms and ANEMIA - sometimes so bad must d/c. genotype dosing for ribavirin. |
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Term
| What are protease inhibitors for Hep C? |
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Definition
- Bocepravir/Victrelis
- Telaprevir/Incivek
**Must combo with Intron/Ribavirin
See almost 100% success rate! But cost prohibitive. |
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