Cirrhosis Flashcards by Alice Richards

Q

cholestasis dt any cause can cause

A

pruritis

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Q

6 cholestasis conditions

A

intrahepatic cholestasis of pregnancy

primary sclerosing cholangitis

malignant biliary tract obstruction

chronic viral hep

nonmalignant biliary tract obstruction

cirrhosis

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Q

elevated levels of bile acids in the skin act as

A

pruritogens

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Q

what are endogenous opioids

A

opioids produced by the body → elevated in chronic liver dz

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Q

studies show that pt’s w. cholestatis pruritis have higher serum levels of (2)

A

LPA (lysophosphatidic acid)

autotaxin

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Q

1st line tx for cholestatic pruritis

A

bile acid sequestrant

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Q

contraindications for bile acid sequestrant (2)

A

intrahepatic cholestasis of pregnancy

primary biliary cholangitis

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Q

2 examples of bile acid sequestrants

A

cholestyramine (Questran)

colestipol (Colestid)

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Q

2nd line tx for cholestatic pruritis

A

rifampin (rifampicin)

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Q

3d line tx for cholestatic pruritis

A

opioid antagonists

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Q

vivitrol is an

A

opioid antagonist

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Q

last line tx for cholestatic pruritis

A

sertraline

OR

phenobarbitlol

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Q

order of tx for cholestatic pruritis

A

bile acid sequestrant
rifampin
opioid antagonist
sertraline OR phenobarbital

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Q

what class of drug does NOT help for cholestatic pruritis

A

antihistamines

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Q

what factors does the MELD use (7)

A

bilirubin

creatinine

INR

recent dialysis

Na

sex (female)

albumin

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Q

what value changed on MELD 3.0

A

Cr cutoff

Q

higher MELD scores are associated w. (2)

A

worse liver dysfxn

higher mortality

Q

MELD is used to prioritize

A

pt’s awaiting liver transplant

Q

7 complications of cirrhosis

A

variceal hemorrhages

ascites

SBP

hepatic encephalopahy

hepatic hydrothorax

HCC

hepatopulmonary syndrome

Q

screening for variceal hemorrhages

A

EGD

Q

tx for variceal hemorrhages

A

band ligation

Q

tx for ascites

A

diuretics

paracentesis

Na restriction

Q

specific diuretics and dosing for ascites tx

A

spironolactone/furosemide 100:40

Q

tx for SBP

A

cefotaxime

Q

any pt w. past SBP infxn needs

A

prophylactic abx

Q

tx for hepatic encephalopathy (2)

A

lactulose/lactitol
rifamixin

Q

tx for hepatic hydrothorax (2)

A

diuretics

Na restriction

Q

tx for HCC (2)

A

surgical resection

tranplant

Q

tx for hepatopulmonary syndrome (2)

A

liver transplant

long term O2

Q

screening for HCC

A

serial US

Q

screening for hepatic encephalopahy

A

detailed neuro exam and testing

Q

what screening tool is used for etoh abuse

A

CAGE

Q

what does CAGE stand for

A

thought about cutting down on your drinking?

annoyed by criticism of your drinking?

guilt about drinking?

drink as eye-opener in the AM?

Q

tx for COPD

A

tiotropium (spiriva)

PLUS

short acting rescue inhaler

Q

tx for cirrhosis (3)

A

diuretics

+/- paracentesis for ascites

edema management