Conrad Fisher's Liver Flashcards
What drug should be used to treat the edema and ascites caused by cirrhosis?
spidonolactone (or aldactone)
What should be done for a cirrhotic pt who is bleeding?
fresh frozen plasma
What is the best acute treatment for bleeding esophageal varices?
banding
What kind of drug should be given as prophylaxis against future bleeding from esophageal varices?
β-blockers
What should be given for hepatic encephalopathy?
lactulose
How does lactulose treat hepatic encephalopathy?
causes ammonia to be excreted from the colon
Why do pts w/ cirrhosis develop thrombocytopenia?
portal htn –> splenomegaly
What are the criteria for transfusing plts in cirrhotic pts?
bleeding and plt < 50,000
What is the SAAG?
Serum-Ascites Albumin Gradient (difference)
What is the SAAG in portal htn?
> 1.1
What if the SAAG is less than 1.1?
the ascites is due to malignancy or some other cause aside from portal htn
Pt. has peritonitis. The SAAG is >1.1. What kind of peritonitis is this?
spontaneous bacterial peritonitis (SBP)
What are the criteria for spontaneous bacterial peritonitis, other than SAAG >1.1?
> 500 WBC, >250 NΦs/μL
What are 4 of the most common organisms responsible for spontaneous bacterial peritonitis?
E. coli, Klebsiellla, Pneumococcus, and Enterococcus
What is the best drug for SBP (if caused by the usual suspects)?
Cefotaxime
Why isn’t ceftriaxone as good as cefotaxime for cirrhotic pts w/ SBP, even though it has the same spectrum of activity?
metabolized by liver
cefotaxime renally metabolized
Itchy, middle-aged female w/ elevated alk phos. Suspect what?
primary biliary cirrhosis
What is the etiology of primary biliary cirrhosis?
Abs against biliary ducts
What special Ab is seen in primary biliary cirrhosis?
anti-mitochondrial
What is the most accurate test for most causes and effects of cirrhosis?
liver biopsy
What is the most accurate test for primary sclerosing cholangitis?
ERCP
What 2 drugs are best for treating primary sclerosing cholangitis or primary biliary cirrhosis?
cholestyramine or ursodeoxycholic acid
What is the mechanism of cholestyramine and ursodeoxycholic acid in treating primary biliary disease?
bind cholesterol and bile acids for excretion
