Conrad Fisher's Liver

Question 1

What drug should be used to treat the edema and ascites caused by cirrhosis?

Answer 1

spidonolactone (or aldactone)

Question 2

What should be done for a cirrhotic pt who is bleeding?

Answer 2

fresh frozen plasma

Question 3

What is the best acute treatment for bleeding esophageal varices?

Answer 3

banding

Question 4

What kind of drug should be given as prophylaxis against future bleeding from esophageal varices?

Answer 4

β-blockers

Question 5

What should be given for hepatic encephalopathy?

Answer 5

lactulose

Question 6

How does lactulose treat hepatic encephalopathy?

Answer 6

causes ammonia to be excreted from the colon

Question 7

Why do pts w/ cirrhosis develop thrombocytopenia?

Answer 7

portal htn –> splenomegaly

Question 8

What are the criteria for transfusing plts in cirrhotic pts?

Answer 8

bleeding and plt < 50,000

Question 9

What is the SAAG?

Answer 9

Serum-Ascites Albumin Gradient (difference)

Question 10

What is the SAAG in portal htn?

Answer 10

> 1.1

Question 11

What if the SAAG is less than 1.1?

Answer 11

the ascites is due to malignancy or some other cause aside from portal htn

Question 12

Pt. has peritonitis. The SAAG is >1.1. What kind of peritonitis is this?

Answer 12

spontaneous bacterial peritonitis (SBP)

Question 13

What are the criteria for spontaneous bacterial peritonitis, other than SAAG >1.1?

Answer 13

> 500 WBC, >250 NΦs/μL

Question 14

What are 4 of the most common organisms responsible for spontaneous bacterial peritonitis?

Answer 14

E. coli, Klebsiellla, Pneumococcus, and Enterococcus

Question 15

What is the best drug for SBP (if caused by the usual suspects)?

Answer 15

Cefotaxime

Question 16

Why isn’t ceftriaxone as good as cefotaxime for cirrhotic pts w/ SBP, even though it has the same spectrum of activity?

Answer 16

metabolized by liver

cefotaxime renally metabolized

Question 17

Itchy, middle-aged female w/ elevated alk phos. Suspect what?

Answer 17

primary biliary cirrhosis

Question 18

What is the etiology of primary biliary cirrhosis?

Answer 18

Abs against biliary ducts

Question 19

What special Ab is seen in primary biliary cirrhosis?

Answer 19

anti-mitochondrial

Question 20

What is the most accurate test for most causes and effects of cirrhosis?

Answer 20

liver biopsy

Question 21

What is the most accurate test for primary sclerosing cholangitis?

Answer 21

ERCP

Question 22

What 2 drugs are best for treating primary sclerosing cholangitis or primary biliary cirrhosis?

Answer 22

cholestyramine or ursodeoxycholic acid

Question 23

What is the mechanism of cholestyramine and ursodeoxycholic acid in treating primary biliary disease?

Answer 23

bind cholesterol and bile acids for excretion