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GI Exam 2 > Ascites > Flashcards

Ascites Flashcards

1
Q

decreased _____ can lead to ascites

A

Oncotic pressure

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2
Q

What can lead to a fluid shift from intra to extra vascular?

A

Low albumin

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3
Q

When the kidneys sense hypoperfusion, what is increased? 2

A
  1. Renin
  2. Aldosterone
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4
Q

To prevent ascites, what needs to be managed?

A

Portal hypertension

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5
Q

What nutrition requirements would help prevent ascites?

A
  1. Maintain protein intake
  2. Mild salt restriction
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6
Q

What is the weight loss goal through diuresis?

A

0.5 kg daily

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7
Q

What is the Spironolactone: Furosemide ratio?

A

100:40

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8
Q

What is the target dose for Spironolactone in ascites?

A

400 mg

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9
Q

What is the target dose for furosemide in ascites?

A

160 mg

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10
Q

Spironolactone can cause ____kalemia

A

Hyper

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11
Q

Furosemide can cause _____kalemia

A

Hypo

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12
Q

What drug should you consider for refractory ascites?

A

Midodrine

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13
Q

What needs replaced in refractory ascites?

A

Albumin

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14
Q

What surgery can a patient receive for refractory ascites?

A

Trans jugular intrahepatic portosystemic shunt (TIPS)

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15
Q

What is the MOA of midodrine?

A

Alpha 1 agonist

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16
Q

What does midodrine help maintain for the diuretics to be increased?

A

Blood pressure

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17
Q

What are 4 ADRs for midodrine?

A
  1. Urinary retention
  2. Itching
  3. Hypertension
  4. Paresthesia
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18
Q

Drainage of the fluid is called

A

Paracentesis

19
Q

What can lead to hepatorenal syndrome?

A

Hypotension

20
Q

What needs to be utilized to avoid a ascitic leak?

A

Z track technique

21
Q

What are 3 complications of paracentesis?

A
  1. Bleeding
  2. Ascitic fluid leak
  3. Infection
22
Q

When is albumin replacement recommended?

A

When >5 L of fluid is removed

23
Q

What preparation of albumin is used?

A

25%

24
Q

What is the dose for albumin replacement?

A

8g/L

25
Q

Renal failure due to hypoperfusion of the kidneys

A

Hepatorenal syndrome

26
Q

What 2 drug classes MUST be avoided in hepatorenal failure?

A
  1. NSAIDs
  2. Aminoglycosides
27
Q

What type of hepatorenal failure?: slow progressive renal failure

A

Type 2

28
Q

What type of hepatorenal failure?: acute renal failure

A

Type 1

29
Q

What type of hepatorenal failure?: May respond to therapy and improve to baseline renal function

A

Type 1

30
Q

What type of hepatorenal failure?: no effective treatment can stop progression

A

Type 2

31
Q

What type of hepatorenal failure?: Has better prognosis

A

Type 1

32
Q

What are 3 symptoms of spontaneous bacterial peritonitis?

A
  1. Fever
  2. Abdominal pain
  3. Mental status changes
33
Q

What is the translocation of intestinal bacteria into the peritoneum due to?

A

Decreased bowel motility, increased bacterial growth, increased intestinal permeability

34
Q

What is the main thing needed for primary prophylaxis of bacterial peritonitis?

A

Low ascitic fluid protein (<1.5 g/L)

35
Q

What 4 additional things are needed for primary prophylaxis in spontaneous bacterial peritonitis?

A
  1. Impaired renal function (SCr >1.2)
  2. BUN >25
  3. Sodium <130 mEq
  4. Liver failure (Child’s Pugh >9 and bilirubin >3 mg/dL)
36
Q

What patients need secondary prophylaxis for spontaneous bacterial peritonitis?

A

ALL patients with SPB diagnosis and liver disease

37
Q

What are 2 prophylactic agents needed for SBP?

A
  1. Ciprofloxacin
  2. Bactrim (quinolone intolerance)
38
Q

What is the PMN count that is needed for diagnosis of SBP?

A

> 250 mm3

39
Q

What needs to be assessed for SBP?

A

If community or hospital-acquired

40
Q

What is the criteria for monitoring if the bacteria community or hospital acquired?

A
  1. > 48 hours in the hospital on current admission or within 3 months
  2. Recent utilization of IV antibiotics (90 days)
41
Q

If the SBP is community acquired what is used for treatment?

A
  1. Cefotaxime
  2. Ceftriaxone
    (Use quinolones if allergy)
42
Q

If the bacteria is nosocomial what is used to treat?

A
  1. Zosyn
  2. Cefipime
  3. Carbapenems
    (If MRSA positive add vancomycin)
43
Q

How long are IV antibiotic used?

A

5 days

44
Q

If HVPG is reduced by ___% or more ascites improves or is prevented

A

10

GI Exam 2 (11 decks)

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