Chronic Liver Disease ES

Possible liver tests to assess liver function

- ALT, AST

- alkaline phosphatase

- bilirubib

- thrombocyte count

- prothrombin time

- serum albumin

- hyponatremia

Drugs that can cause CLD

- methotrexate

- amiodarone

- methyldopa

- tamoxifen

Ascites

- accumulation of fluid in peritoneal space

- most common condition associated with decompensated cirrhosis and indicates poor prognosis

Treatment of ascites

- IV albumin after large volume parancentesis

- diuretics (spironolactone first line, loop diuretics add-on)

Variceal bleeding

- weak, superficial vessels that develop due to hepatic fibrosis and portal hypertension blocking blood flow from GI tract to liver

- can rupture and bleed easily

Treatment of variceal bleeding

- octreotide

- pts at high risk for SBP --> prophylactic abx (ceftriaxone)

MOA: octreotide

causes selective vasoconstriction of splanchnic bed, decreasing portal venous pressure with few serious side effects

Hepatic coagulopathy

- liver manufacturers procoagulant and anticoagulant factors; in advanced disease it is unable to manufacture these

- signal end stage liver disease

Treatment hepatic coagulopathy

vitamin K

Spontaneous bacterial peritonitis

acute bacterial infection of usually sterile peritoneal fluid in the absence of intra-abdominal infection

How does SBP happen?

translocation of intestinal bacteria to mesenteric lymph nodes, which then starts growing in the ascitic fluid

Treatment for SBP

- IV third gen cephalosporin (cefotaxime, ceftriaxone)

What is the most common cause of liver disease worldwide?

metabolic dysfunction associated steatitic liver disease (MASLD)

What causes hepatic encephalopathy?

systemic circulation bypasses the liver and substances that are normally metabolized by the liver accumulate in systemic circulation --> these byproduct are neurotoxic

What byproduct/metabolite causes the most problems with hepatic encephalopathy?

ammonia

Symptoms of hepatic encephalopathy

- decreased cognition

- confusion

- changes in behavior

- asterisks (flapping of hand when extend arms)

Treatments for hepatic encephalopathy general

- lactulose

- rifamixin

- neomycin

Lactulose for HE

prevents and treats HE

MOA: lactulose

lowers colonic pH by drawing water into colon and stimulating defecation, which favors conversion of ammonia to ammonium; b/c ammonia is ionized, it cannot cross back into systemic circulation

Rifamixin use for HE

non absorbable antibiotic that decreases urease-producing gut bacteria, decreasing ammonia production

What is portal hypertension?

- increased blood pressure in the portal vein

- consequence of increased resistance to hepatic blood flow

Esophageal varices cause

splanchnic system drains venous blood from GI tract to the liver; portal HTN blocks this blood flow, so collateral vessels (varices) develop in the esophagus to compensate for the increase in pressure and blood volume

Treatment for portal HTN

non-selective BB blockers (propranolol and nadolol)

Why do we use non-selective BB for portal HTN?

- blockade of beta-1 --> reduces cardiac output and splanchnic blood flow

- blockade of beta-2 --> causes splanchnic vasodilation allowing for unopposed a-adrenergic effects, enhancing vasoconstriction of systemic and splanchnic vascular beds