Session 2
What are the true measures of liver function? What else can elevate these labs? (Taiba)
The term liver function tests is misleading since most of the values do not reflect how well the liver is actually functioning. The evaluation of liver enzymes just gives the information whether a patient’s primary disorder is hepatic or cholestatic in origin. In other words AST/ALT, bilirubin, GGT, ALP are more so indicators of liver damage rather than function.
True liver function tests include: Albumin, prothrombin time and clotting factors.
Albumin is a plasma protein synthesized by the liver. Normal persons synthesize 12-15 g of albumin a day. Albumin synthesis can double in the face of excessive catabolism or loss of albumin from the body. The normal half-life for albumin is about 20 d (1), but can be decreased to 7 d in nonhepatic febrile illness or trauma.
Because albumin is the major protein synthesized by the liver, its plasma level is helpful in assessing the severity and chronicity of liver diseases. Hypoalbuminemia is not shown in acute liver damage due to its long half life. It is mainly present in chronic liver disease such as cirrhosis. Hypoalbuminemia does not always reflect the presence of hepatic dysfunction since a variety of other conditions may be responsible including systemic inflammation, the nephrotic syndrome, and malnutrition.
Hyperalbuminemia on the other hand is also seen in patients with volume depletion, high protein diets and genetic variants who have a longer albumin half life.
Clotting Factors:
The liver synthesized clotting factors and PT prothrombin is one of them. The other are fibrinogen, factor 5,7,9 and 10, 12 and 13. Elevations in PT may be an indicator for hepatocellular protein synthesis abnormalities. It can result from congenital or acquired conditions including consumption of clotting factors like gI bleeding and DIC. However when these conditions are excluded a prolonged PT can either be due to a deficiency in Vitamin K or advanced parenchymal liver disease. When there is advanced parenchymal liver disease administration of Vitamin k supplements is usually ineffective.
Session 3
The 5 antibiotics I choose for my hospital were based on coverage and the populations they would be useful for.
Amoxicillin: I chose this antibiotic since it can treat gram positive cocci, some gram-negative bacilli, and N. meningitis. It is from the class of penicillians and has more coverage than Penicillin G but it is not so broad, since it can’t treat pseudomonas, N. gonorrhoeae, anaerobes and atypicals. Also, This antibiotic is commonly used in the pediatric population for strep, otitis media, tonsillitis, pneumonia, and more. Adverse effects are mild and mainly include headache, diarrhea, nausea and vomiting.
Azithromycin: I chose to include this antibiotic since it is used for respiratory, enteric and genitourinary infections. It covers gram positive cocci, gram negative cocci and atypicals. Azithromycin can be given as an alternative, when a patient is allergic to penicillin. Compared to other macrolides it has higher efficacy with STIs, does not interact significantly with cytochrome P450 which means less drug-drug interactions and it is safe during pregnancy.
Ceftriaxone: This antibiotic can treat lower respiratory infections, UTIs, meningitis, skin infections and PID. Additionally, I included it since it can treat N. gonorrhoeae while the other antibiotics on this list did not. There are no known drugs that interact with Ceftriaxone. It can be used in a variety of settings, emergency department, ob/gyn, surgery, pediatrics, just to name a few.
Zosyn (Piperacillin + Tazobactam): Included this antibiotic since it has very broad coverage. It covers anaerobes and pseudomonas which the other antibiotics on this list do not do. It is also often used in surgical specialty. Some of its uses are pneumonia, appendicitis, pelvic inflammatory disease, E.coli, cellulitis, and postpartum endometriosis. Since this antibiotic is so broad spectrum, it should be used cautiously.
Vancomycin: This is a narrow spectrum antibiotic since it covers only MRSA, MSSA. Streptococci. However, it is very important since it treats many nosocomial infections, catheter related infections, pneumonia, bacterial meningitis, necrotizing skin infections and more. It can also treat c.diff which is a risk with the use of any antibiotic and can be life threatening if not treated. It can be used for surgery prophylaxis, surgical-site infections. Essentially it can treat many serious infections. Vancomycin would be useful in many units of the hospital.
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