Alcohol-Induced Liver Disease Exam 3 Flashcards
S/S of Cirrhosis
- Ascites
- Jaundice/Icterus
- Clay colored stools
- Cola colored urine
- Palmar erythema
- Altered mental status
- Asterixis
- Abdominal pain
- Spider angiomas
S/S of Esophageal Varices / Variceal Bleed (EVB)
- Severe hematemesis
- Melena
- Hematochezia
S/S of Ascites
- Protruding abdomen
- Pitting edema
- Positive fluid wave
- Shifting dullness
- Abdominal pain / discomfort
S/S of Spontaneous Bacterial Peritonitis (SBP)
- Fever
- Leukocytosis
- Diffuse abdominal pain with rebound tenderness
- Altered mental status
- Worsening HE
- Hypotension
- Ascites
S/S of Hepatic Encephalopathy (HE)
- Altered mental status
- Asterixis
In cirrhosis, what are the labs that are indicative of obstruction?
- ↑ Bilirubin (or damage)
- ↑ Alk phos
- ↑ GGT
- If both alk phos and GGT are high, suggest a hepatic source
What are the labs that you can see in Alcohol liver disease?
- AST at least twice ALT (individual elevations typically less than 500 IU/L)
- ↑ bilirubin
What does the Maddrey discriminant function (MDF) score predict?
Predicts short-term prognosis
Maddrey discriminant function (MDF) score and when to treat
- Score ≥ 32 indicates poor prognosis
- pharmacologic treatment if MDF ≥ 32
What are the treatment options based on the MDF score?
- Prednisolone 40 mg daily x 28 days followed by a taper (preferred)
- Pentoxifylline 400 mg TID x 28 days (alternative if steroid contraindications)
contraindications for prednisolone
- active GI bleed
- infection
What are the goals for treating ascites?
Make patient comfortable - will not completely eliminate ascites
Nonpharmacologic treatment for ascites
- Alcohol abstinence
- Restrict sodium to < 2g/day
- Fluid restriction if sodium is less than 120-125 mEq/L
- For tense ascites or refractory ascites -> Paracentesis
- If removing > 5 liters, give 6-8 g albumin per liter of fluid removed to maintain oncotic pressure
Pharmacologic treatment for ascites
- Spironolactone (Aldactone ®) 100 mg/day PO
- Furosemide (Lasix ®) 40 mg/day PO
- Maintain 100 mg: 40 mg ratio for normal potassium levels (normokalemia)
- Max dose: spironolactone 400 mg + furosemide 160 mg
monitoring parameters for ascites
- blood pressure
- electrolyte imbalances
- renal function
- gynecomastia
- fluid balance
- mental status
- daily weight
- ins and outs