Decompensated Cirrhosis and Liver Transplantation Flashcards
What is the mainstay of treatment for ascites?
sodium restriction and diuretic therapy (spironolactone > frusemide)
Why should diuretics be discontinued in diuretic refractory ascites?
worsens renal function
What is the median survival of diuretic refractory ascites?
6 months
What is required for diagnosis of SBP?
neutrophils > 250 or leuks > 500
What is the treatment for SBP?
IV abx (3rd generation cephalosporin or tazocin) for 5-7 days
Repeat paracentesis in 48 hours
Albumin infusion 1-1.5g/kg/day for first 3 days
Who should receive primary prophylaxis for SBP?
low protein (<10g/L) ascites or bilirubin > 50 with impaired renal function or anyone with clinically significant ascites
Which antibiotic is used for primary prophylaxis for SBP?
norfloxacin
How often should cirrhotic patients be screened for varices?
yearly if small varices
second yearly if no varices
What are the predictors of variceal bleeding?
varix size child class endoscopic stigmata (e.g. red wale mark) continued alcohol abuse pressure gradient > 12 previous bleed
What is used for primary prophylaxis for high risk varices?
propranolol or banding
What is the mainstay of treatment for HRS?
terlipressin and albumin
What is the mechanism of action of terlipressin?
long acting vasopressin analogue, reverses splanchnic vasodilation
