Cirrhosis summary

Question 1

1st line therapy for ascites?

Answer 1

Spironolactone + Furosemide

If large volume= paracentesis

Question 2

When to use prophylaxis for ascites

Answer 2

Primary- N/A
Secondary- aimed at preventing need for paracentesis.
(use spironolactone/furosemide)

Question 3

Monitoring Ascites

Answer 3

s/sx of ascites, Scr, K+

Question 4

When to treat for EV

Answer 4

Active variceal hemorrhage (VH)

Question 5

1st line therapy for EV

Answer 5

Octreotide, ceftriaxone, transfusion, EVL

Question 6

When to use prophylaxis for EV

Answer 6

secondary- after VH use NSBB (as long as BP and HR tolerates) or EVL

Question 7

monitoring for EV

Answer 7

s/sx of bleeding
HR goal 55-60 BPM, BP goal >90

Question 8

When to treat for SBP

Answer 8

Confirmed positive culture or PMN > 250K

Question 9

1st line tx for SBP

Answer 9

Ceftriaxone (or 3rd gen cephalosporin + albumin during day 1 and day 3

Question 10

when to do prophylaxis with SBP?

Answer 10

Secondary- After SBP, indefinite

primary- active vH (7 day tx)

Question 11

1st line prophylaxis for SBP?

Answer 11

bactrim

Question 12

Monitoring SBP tx?

Answer 12

s/sx infection, SCr

Question 13

When to treat hepatic encephalopathy

Answer 13

If someone is confused

Encephalopathy +/- increased ammonia (rule out other causes)

Question 14

1st line therapy for HE

Answer 14

lactulose (target >3 BM a day)

Question 15

When to use prophylaxis for HE

Answer 15

secondary- after any occurence of HE

Question 16

1st line prophylaxis of HE

Answer 16

Lactulose

Question 17

Monitoring HE

Answer 17

BMs, mental status, NOT AMMONIA