Liver Disease

• Functions of the liver

  • Clearance (aldosterone, drugs)
  • Storage (vitamins, glycogen)
  • Homeostasis (glucose levels regulation)
  • Synthesis (albumin, clotting factors)
  • Metabolism (vitamin D)
  • Secretion (bile salts)
  • Excretion (cholesterol)
• Management of portal hypertension, encephalopathy, ascites, hepatorenal syndrome


  • Pathophysiology
  • First line class of medication used with one example
• Cirrhosis


  Chronic liver damage from a variety of causes leading to scarring and liver failure
• Portal hypertension


  • Increase pressure within the portal venous system
  • Cirrhosis slows down the blood flow and puts stress on the portal vein leading to heightened pressure
• Beta blockers


  First line of medication (reduce cardiac output)
• Beta blockers


  • Propranolol
• Encephalopathy


  • CNS disturbance associated with hepatic insufficiency and liver failure
  • Drug therapy to reduce blood ammonia concertation, inhibition of GABA receptors
• Encephalopathy medication


  • Lactulose
• Ascites


  • The accumulation of lymph fluid in the peritoneal cavity
  • Less blood flow to the liver leads to albumin fluid leaking through capillaries
• Frusemide


  Loop diuretic
• Hepatorenal syndrome


  • Progressive renal failure associated with cirrhosis
  • Gradual rise of creatine while urine output falls
• Hepatorenal syndrome medication


  • Antibiotics, norfloxacin (vasopressin analogue)
• Functions of the kidneys


  • Remove waste products from the blood and produce urine
  • Water balance
  • Electrolyte balance
  • Acid base
  • Activation of vitamin B
• Kidney function processes


  • Filtration
  • Absorption
  • Secretion
• Risk factors for kidney disease

  • Diabetes
  • High blood pressure
  • Heart disease
  • Obesity
  • Family history of kidney disease
  • Older age
  • Smoking
  • Certain ethnicities
  • Kidney stones
  • Chronic urinary tract infections
  • Prolonged use of certain medications (diuretics, ACE inhibiters, NSAIDS)
• Steps in urine formation

  1. Filtration

  2. Reabsorption

  3. Secretion
• Filtration


  • Takes place in the renal corpuscle
  • Glomerulus filters the blood and removes water and other substances
  • High pressured system
  • GFR maintained by factors such as cardiac output, SNS tone, blood pressure, vascular volume
  • Feedback mechanism that keeps renal blood flow (RBF) and GFR constant despite changes in arterial blood pressure
• Reabsorption

  • Reabsorption occurs when filtered material is moved back into the blood
  • Moves nutrients and water that has been filtered back into bloodstream
• Secretion

  • Secretion removes selected material from the blood and places it in the filtrate
  • Waste products are secreted from the blood and form urine to be removes
• Categories of AKI


  • Prerenal
  • Intrarenal
  • Postrenal
• Cockcroft-Gault equation


  Used to estimate creatinine clearance, which is a measure of kidney function
• eGFR formula


  Used to estimate the glomerular filtration rate, which is a more accurate measure of kidney function
• Drugs constituting triple whammy

  • NSAID
  • ACE inhibitors
  • Diuretics
• Mechanism of renal damage from triple whammy

  • Producing hypovolemia, and reduction of glomerular filtration rate and glomerular perfusion
  • Interferes with these compensatory mechanisms, and hence may produce renal failure
• Anaemia in renal disease

  • Decrease in the production of erythropoietin (EPO) by the kidneys, leading to reduced red blood cell production in the bone marrow
  • Prior to commencing erythropoietin stimulating agents (ESA), trial of iron supplementation is recommended maintaining transferrin saturation (TSAT) >20% and ferritin between >100 μg/L
• Hyperkalaemia in renal disease

  • The kidneys play a crucial role in potassium balance by excreting excess potassium into the urine
  • Remove drugs contributing, reducing potassium dietary intake, potassium wasting diuretics
• Renal bone disease


  • Characterized by abnormalities in calcium, phosphorus, parathyroid hormone (PTH), and vitamin D metabolism, leading to skeletal complications
  • Controlling serum phosphorus and PTH levels while maintaining adequate vitamin D levels
  • Dietary phosphorus restriction, phosphate binders, and dialysis are used to manage hyperphosphatemia
• Drugs excreted by the kidneys

  • Antibiotics: penicillins, cephalosporins, aminoglycosides, tetracycline
  • Beta blockers
  • Diuretics
  • Lithium
  • Digoxin
  • Procainamide
  • Cimetidine
  • Ranitidine