E4 hepatology

Question 1

3 objective markers for liver injury

Answer 1

aspartate transaminase (AST)
alanine transaminase (ALT)
Alkaline phosphatase (Alk phos)

Question 2

AST normal range

Answer 2

0-50

Question 3

ALT normal range

Answer 3

0-50

Question 4

Alk phos normal range

Answer 4

30-120

Question 5

T or F:
Term LFTs are true markers of liver function

Answer 5

False, “are NOT”

Question 6

elevated ______ can be a sign of acute and/or chronic liver issues

Answer 6

bilirubin

Question 7

chronic liver disease can decrease liver production of ______ resulting in what?

Answer 7

protein
dec albumin, inc INR and/or inc bilirubin * quiz question

Question 8

how much acetaminophen to result in toxic levels of NAPQI

Answer 8

> 8g

Question 9

s/sxs of acetaminophen DILI

Answer 9

ab pain
jaundice
N/V/D

Question 10

how do you assess severity of acetaminophen DILI? (3)

Answer 10

AST
ALT
acetaminophen conc

Question 11

what is the reversal agent for aceta DILI?

Answer 11

NAC +/- activated charcoal

Question 12

MOA of NAC

Answer 12

binds to NAPQI, decreasing hepatotoxic effects

also something with glutathione

Question 13

NAC is based on conc of aceta >_ hours after ingestion and timing since ingestion

Answer 13

4

Question 14

when dosing NAC what form(s) do you use?

Answer 14

start with an oral loading dose then do IV after for 72 hours

Question 15

monitoring for NAC

Answer 15

liver enzymes and s/sxs of acute liver injury

Question 16

T or F:
Cirrhosis is reverisble

Answer 16

nope, irreversible

Question 17

1 cause of cirrhosis

Answer 17

alcohol

Question 18

chronic use of what two drugs can cause cirrhosis (not tylenol)

Answer 18

amiodarone and MTX

Question 19

what is jaundice caused by

Answer 19

accumulation of bilirubin

Question 20

what does MELD (model for end-stage liver disease) predict? *

Answer 20

3 month mortality

Question 21

4 s/sxs of ascites

Answer 21

ab distension
ab pain
sob
nausea

Question 22

compensatory mechanisms from portal htn result in ?

Answer 22

inc fluid retention

Question 23

what can uncontrolled ascites cause

Answer 23

SBP and hepatorenal syndrome

Question 24

2 non-pharm things for ascites management

Answer 24

Na restriction (<2g/day)
assess for liver transplant

Question 25

first line for ascites management

Answer 25

spiro + furo

Question 26

2nd line for ascites

Answer 26

paracentesis TIPS

Question 27

avoid ______ in pts with cirrhosis

Answer 27

NSAIDs no shit

Question 28

rec ratio for spiro and furo for ascites

Answer 28

100:40

Question 29

T or F: furosemide is superior to spiro in cirrhosis

Answer 29

false, other way around

Question 30

3 side effects with spiro

Answer 30

AKI inc K gynecomastia

Question 31

2 side effects furo

Answer 31

AKI dec K

Question 32

3 monitoring things for ascites

Answer 32

s/sxs of ascites SCr K

Question 33

when is paracentesis indicated?

Answer 33

refractory/resistant ascites or in AKI*

Question 34

when do you administer albumin with paracentesis

Answer 34

if >5L is removed

Question 35

what percentage of albumin do you give IV?

Answer 35

25%

Question 36

how much albumin to give per liter removed?

Answer 36

6-8 g

Question 37

portal htn causes hepatic/splanchnic _________ resulting in decreased perfusion

Answer 37

vasodilation

Question 38

if you see offshoots what do you think about

Answer 38

EV

Question 39

4 risk factors for variceal bleeding

Answer 39

varices size cirrhosis red color markings from endoscopy alcohol use

Question 40

what is EVL

Answer 40

endoscopic variceal ligation

Question 41

T or F: NSBBs and EVL showed a decrease in variceal and Gi bleeding with mortality benefit

Answer 41

false, no effect on mortality

Question 42

primary prophylaxis for variceal bleeding

Answer 42

NSBB or EVL (not in combo tho)

Question 43

B2 antagonism =

Answer 43

splanchnic vasoconstriction

Question 44

B1 antagonism=

Answer 44

dec HR and dec CO

Question 45

3 NSBBs

Answer 45

NPC

Question 46

3.5 side effects of NSBB

Answer 46

drowsiness/insomnia bradycardia hypotension

Question 47

HR goal for NSBBs

Answer 47

55-60

Question 48

BP goal for NSBBs (SBP)

Answer 48

SBP > 90

Question 49

esophageal varices are asymptomatic, how do you visualize them?

Answer 49

endoscopy

Question 50

5 s/sxs under variceal bleeding clinical presentation

Answer 50

hematemesis melena fatigue lightheaded/dizzy hypotension

Question 51

somatostatin analog that vasoconstricts

Answer 51

ocreotide

Question 52

tx of variceal bleeding: - octreotide - _________ prophylaxis

Answer 52

blood transfusions* antibiotic

Question 53

what is not recommended for variceal bleeds

Answer 53

PPis

Question 54

octreotide inhibits release of ____________ resulting in splanchnic ___________ and decreased blood flow

Answer 54

vasodilatory peptides vasoconstriction

Question 55

indications of ocrtreotide

Answer 55

acute variceal bleed (not any other types of GI bleeds)

Question 56

in practice, when do you usually stop octreotide?

Answer 56

24 hours after successful EVL

Question 57

4 side effects under octreotide

Answer 57

N/V htn bradycardia hyperglycemia

Question 58

4 things to monitor for octreotide

Answer 58

s/sxs BP HR BG

Question 59

what is the gold standard for variceal bleeding cessation

Answer 59

EVL

Question 60

how fast do you want to complete an EVL upon presentation

Answer 60

12 hours

Question 61

what antibiotic recommended for prophylaxis for variceal bleedign

Answer 61

ceftriaxone

Question 62

1 side effect ceftriaxone

Answer 62

diarrhea

Question 63

T or F: ceftriaxone is renally adjusted in CrCl <50

Answer 63

false dumbass its not renally cleared

Question 64

duration of ceftriaxone

Answer 64

until hemorrhage resolution (max of 7 days)

Question 65

secondary prophylaxis for varices

Answer 65

EVL every 1-4 weeks (how tf does this work?) NSBBs indefinitely

Question 66

what is the proposed patho of HE

Answer 66

accumulation of ammonia

Question 67

primary s/sxs of HE

Answer 67

altered mental status and a bunch of other mental shit

Question 68

first line HE

Answer 68

lactulose

Question 69

counseling for lactulose

Answer 69

GI side effects, hydrate mucho

Question 70

what thing under SBP clinical presentation did isaacs say was unique to SBP 10 times?

Answer 70

abdominal pain/ tenderness

Question 71

diagnosis of SBP

Answer 71

ascitis fluid with >250 cells with PMN

Question 72

SBP treatment

Answer 72

ceftriaxone again yay + albumin dec mortality

Question 73

how to dose albumin for SBP

Answer 73

Day 1: 1.5g/kg x 1 (within 6 hours of diagnosis) Day 3: 1g/kg x 1

Question 74

SBP secondary prophylaxis

Answer 74

bactrim or cipro and only once a day instead of 2 like normal

Question 75

what to monitor on bactrim (3)

Answer 75

SCr, electrolytes, CBC

Question 76

what to monitor on cipro

Answer 76

mental status, CBC, renal function