Cirrhosis and HCC

Question 1

What is SAAG?

Answer 1

Serum albumin – ascites albumin

> 11 suggestive of portal HTN

Question 2

What is the primary driver of ascites?

Answer 2

Portal hypertension

Question 3

What is the treatment for SBP?

Answer 3

IV ceftriaxone (or tazocin if on norfloxacin/Bactrim)
IV conc alb (>2 bottles/day for >3/7)

Question 4

What is the starting dose of diuretics for ascites?

Answer 4

Spironolactone 100mg (+/- frusemide 20mg)

Question 5

What are the precipitants for hepatic encephalopathy?

Answer 5

Infection
Bleeding
Constipation
Diarrhoea
Electrolyte derangement
Drugs – opioids/benzos

Question 6

What Is the management for variceal bleeding?

Answer 6

Aim SBP > 90mmHg
Aim Hb > 70
Blood cultures and empirical IV ceftriaxone
Terliperessin
Endoscopy

Question 7

What are the indications for a TIPS procedure?

Answer 7

Variceal bleeding unable to be treated endoscopically
Diuretic refractory ascites/hepatic hydrothorax
Budd chiari

Question 8

What is the adverse effect of a TIPS procedure?

Answer 8

Increased risk of hepatic encephalopathy

Question 9

What is the treatment for HRS?

Answer 9

Avoid nephrotoxic drugs
Treat precipitant
Withhold diuretics
Albumin
Terlipressin

Question 10

Can you give TACE if there is portal hypertension?

Answer 10

No

Question 11

What is the treatment for stage C HCC?

Answer 11

Levatinib, sorafenib