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Liver and Renal Disease > Clinical Questions > Flashcards

Clinical Questions Flashcards

1
Q

What is cirrhosis? What are the causes?

A

Advanced irreversible fibrosis or scarring of the liver

Causes: hepatitis C and alcohol consumption

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2
Q

What are common signs and symptoms of cirrhosis?

A

nausea, loss of appetite, vomiting, malaise, yellow skin and yellow eyes (JAUNDICE), darkened urine, lighter stools (decrease in bile)

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3
Q

General labs trends for acute liver toxicity

A

AST: 10 - 40 = INCREASE
ALT: 10 - 40 = INCREASE

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4
Q

General lab trends for chronic liver disease (cirrhosis)

A

AST: 10 - 40 = INCREASE
ALT: 10 - 40 = INCREASE
albumin: 3.5 - 5.5 = DECREASE
AlkPhos = increased
Total bili = increased
LDH = increased
PT/INR = increased

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5
Q

General lab trends for alcoholic liver disease

A

AST > ALT
(most likely double)
increased GGT

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6
Q

General lab trends that increase when jaundice is present?

A

increase total bilirubin

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7
Q

What classification system helps determine the severity of liver disease?

A

Child=Pugh

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8
Q

When should you discontineu hepatotoxic drugs?

A

When the AST and ALT are > 3x the upper limit
(> 150)

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9
Q

What are common treatments for alcohol associated liver disease to prevent relapse of alcohol abuse?

A

Naltexone (Vivitrol)
Acomprosate
Disulfiram

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10
Q

What vitamins are important for patients with liver damage?

A

Thiamine (vitamin B1)!!!
Vitamin A
Vitamin D
Folate
Pyridoxine (vitamin B6)
Zinc

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11
Q

Which supplement is given to hepatic injury patients to prevent Wernicke-Korsakoff syndrome/ encephalopathy?

A

Thiamine (Vitamin B1)

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12
Q

Portal Hypertension prevention treatment include:

A

Nadolol (Coregard)
Propranolol (Inderal)

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13
Q

Portal Hypertension treatment options:

A

Octreotide (Sandostatin)
Vasopressin

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14
Q

What is the main cause of hepatic encephalopathy?

A

Build up of gut-derived nitrogenous AMMONIA in the blood

^^^ normally get clearly by the liver

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15
Q

What is the first line therapy for hepatic encephalopathy?

A

Lactulose

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16
Q

What is the 2nd line therapy for hepatic encephalopathy?

A

Rifaximin (Xifaxan)

may also add zinc

17
Q

What is ascites?

A

Fluid accumulation in the piritoneal space —- risk for SBP

18
Q

What is the preferred treatment for ascites?

A

Restrict Na+ to < 2 g/day
Spironolactone 100 mg
Furosemide 40 mg

Ratio 50:20 to control K+ level

Next line: Paracentesis

19
Q

What is Spontaneous bacterial peritonitis (SBP)?

A

An acute infection of the ascitic fluid

20
Q

What is the preferred treatment for SBP?

A

Ceftriaxone for 5-7 days

21
Q

What drugs cause kidney disease?

A

NSAIDS
Vanco/AG
Loop diuretics
Cisplatin
Amp B
Cyclosporine /Tacrolimus
Polymyxcins
Radiographic contrast dye

22
Q

A 65 year old female patient who weighs 175 pounds and is 5’4” comes into the ER complaining of edema and abdominal pain.

PMH: HTN, osteoarthritis, CKD
Meds: Advil, Lotensin, Procardia, Bumex

Labs:
SCr 1.8
eGFR 53
Na 147
K 4.7
Ca 8.6
Alb 4.5
ACR 15
What stage is her CKD? What could be the cause of her CKD? What medications could be worsening the CKD?

A

Stage 3 A2

HTN could be the cause

Advil, Bumex

23
Q

What are the CKD staging?

A

> /= 90 Stage 1
60-89 Stage 2
30-59 Stage 3
15 - 29 Stage 4
< 15 or dialysis Stage 5

24
Q

What CrCl is contraindicated with TDF?

A

< 50

25
Q

What CrCl is contraindicated with TAF?

A

< 30

26
Q

What CrCl is contraindicated with Macrobid?

A

< 60

27
Q

What CrCl is contraindicated with Voriconazole?

A

< 50

28
Q

What CrCl is contraindicated with Pradaxa and Xarlto with DVT / PE?

A

< 30

29
Q

Which diabetes medications are contraindicated when eGFR < 30?

A

SGLT-2 i
Metformin

30
Q

What would you use Calcium Acetate for?

A

Phosphate binder in CKD patients

31
Q

When should you take any phosphate binder?

A

BEFORE meals, if you skip a meal skip the dose!

32
Q

What is a first line phosphate binder for CKD?

A

Calcium Carbonate
Calcium Acetate

33
Q

What drugs cause hyperkalemia?

A

ACEE/ARBS
Aldosterone Antagonist
Alskirin
Canagliflozin
Drospirenone (Yaz)
Bactrim
Cyclosporine, Tacrolimus, Everlimus

34
Q

When should you treat metabolic acidosis with sodium bicarb?

A

When the serum bicarb is < 22

Liver and Renal Disease (3 decks)

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