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GI > Ascities and SBP > Flashcards

Ascities and SBP Flashcards

1
Q

What causes ascites?

A
  1. decreased oncotic pressure
  2. low albumin leads to fluid shift from intra to extravascular
  3. increased renin and aldosterone
  4. anti-diuretic horomone activation
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2
Q

How can ascites be prevented?

A
  1. maintain protein intake in early liver disease
  2. mild salt restriction (2-3g / day)
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3
Q

What is the weight loss goal for ascites?

A

0.5 kg daily through diuresis

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4
Q

What is the starting ratio for Spironolactone: furosemide?

A

100mg : 40mg

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5
Q

What are SEs with Spironolactone?

A
  1. hyperkalemia
  2. gynecomastia
  3. gastritis
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6
Q

What are SEs with Furosemide?

A
  1. hypokalemia
  2. hyperuricemia
  3. orthostasis
  4. tinnitus (high-dose)
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7
Q

What dose adjustments should be made if the patient has hyperkalemia and low BP?

A

decrease Spironolactone

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8
Q

What dose adjustments should be made if the patient has hyperkalemia and high BP?

A

increase Furosemide

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9
Q

What dose adjustments should be made if the patient has hypokalemia and low BP?

A

decrease Furosemide

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10
Q

What dose adjustments should be made if the patient has hypokalemia and high BP?

A

increase Spirinolactone

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11
Q

Why are Furosemide and Spironolactone used in combination?

A
  1. balance K+
  2. block kidneys from retaining sodium so diuresis works better
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12
Q

What agents should be used for refractory ascites?

A
  1. Midodrine with high dose diuretics
  2. large-volume paracentesis
  3. TIPS
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13
Q

What is the MOA of Midodrine?

A

alpha-1 agonist

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14
Q

What are SEs with Midodrine?

A

itching
urinary retention
paresthesia
HTN

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15
Q

What are the complications with paracentesis?

A

nicked artery/veins
ascitic fluid leak
infection
hypotension –> hyporenal syndrome

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16
Q

When is albumin replacement recommended?

A

anything more than 5L removes

17
Q

What is the proper dose of albumin?

A

8g/L

18
Q

What medications should be avoided with ascites to prevent hepatorenal failure?

A

NSAIDs
Aminoglycosides

19
Q

What is required for primary SBP prophylaxis?

A

low ascitic fluid protein
AND
impaired renal function or
BUN >25 or
serum sodium <130 or
liver failure

20
Q

What is required for secondary SBP prophylaxis?

A

SPB diagnosis and liver disease

21
Q

What agents are used for SBP prophylaxis?

A

Cipro
Norfloxacin (Canada)
Bactrim (quinolone resistance/allergy)

22
Q

How is SBP diagnosed?

A

PMN > 250
OR any bacterial growth in ascitic fluid

23
Q

What agents are used for community-acquired SBP?

A

Cefotaxime
Ceftriaxone
(quinolones if allergy)

24
Q

What agents are used for nosocomial SBP?

A

Zosyn
Cefepime
Carbapenem
(covers pseudomonas)
add vanco if MRSA

25
Q

When is albumin given for SBP?

A

days 1 and 3

GI (23 decks)

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