Cirrhosis decompensation

Question 1

Secondary prophylaxis against recurrent variceal bleed

Answer 1

A beta blocker

Either nodalol or propranolol

Question 2

Treatment of an acute variceal bleed

Answer 2

Octreotide

Antibiotics

+/- Labetalol (depends who you ask)

Question 3

Last resort for UGI bleeds

Answer 3

Sengstaken-Blakemore tube

Basically blocks off / tamponades the esophagus to prevent bleeding.

Question 4

Prophylaxis for SBP

Answer 4

Indications:

1. Ascites with protein > 1.5 g/dL iso renal impairment or liver failure
2. Previous SBP
3. Cirrhosis + acute GI bleed

Agents: ciprofloxacin, norfloxacin, or batrim

Question 5

Lactate clearance

Answer 5

Mainly mediated by the liver via conversion to glucose

Hence, patients with cirrhosis are often going to carry around a lactate, which is to be expected and is not necessarily because they are hypoperfusing.