E4 hepatology Flashcards
3 objective markers for liver injury
aspartate transaminase (AST)
alanine transaminase (ALT)
Alkaline phosphatase (Alk phos)
AST normal range
0-50
ALT normal range
0-50
Alk phos normal range
30-120
T or F:
Term LFTs are true markers of liver function
False, “are NOT”
elevated ______ can be a sign of acute and/or chronic liver issues
bilirubin
chronic liver disease can decrease liver production of ______ resulting in what?
protein
dec albumin, inc INR and/or inc bilirubin * quiz question
how much acetaminophen to result in toxic levels of NAPQI
> 8g
s/sxs of acetaminophen DILI
ab pain
jaundice
N/V/D
how do you assess severity of acetaminophen DILI? (3)
AST
ALT
acetaminophen conc
what is the reversal agent for aceta DILI?
NAC +/- activated charcoal
MOA of NAC
binds to NAPQI, decreasing hepatotoxic effects
also something with glutathione
NAC is based on conc of aceta >_ hours after ingestion and timing since ingestion
4
when dosing NAC what form(s) do you use?
start with an oral loading dose then do IV after for 72 hours
monitoring for NAC
liver enzymes and s/sxs of acute liver injury
T or F:
Cirrhosis is reverisble
nope, irreversible
1 cause of cirrhosis
alcohol
chronic use of what two drugs can cause cirrhosis (not tylenol)
amiodarone and MTX
what is jaundice caused by
accumulation of bilirubin
what does MELD (model for end-stage liver disease) predict? *
3 month mortality
4 s/sxs of ascites
ab distension
ab pain
sob
nausea
compensatory mechanisms from portal htn result in ?
inc fluid retention
what can uncontrolled ascites cause
SBP and hepatorenal syndrome
2 non-pharm things for ascites management
Na restriction (<2g/day)
assess for liver transplant
first line for ascites management
spiro + furo
2nd line for ascites
paracentesis
TIPS
avoid ______ in pts with cirrhosis
NSAIDs no shit
rec ratio for spiro and furo for ascites
100:40
T or F:
furosemide is superior to spiro in cirrhosis
false, other way around
3 side effects with spiro
AKI
inc K
gynecomastia
2 side effects furo
AKI
dec K
3 monitoring things for ascites
s/sxs of ascites
SCr
K
when is paracentesis indicated?
refractory/resistant ascites or in AKI*
when do you administer albumin with paracentesis
if >5L is removed
what percentage of albumin do you give IV?
25%
how much albumin to give per liter removed?
6-8 g
portal htn causes hepatic/splanchnic _________ resulting in decreased perfusion
vasodilation
if you see offshoots what do you think about
EV
4 risk factors for variceal bleeding
varices size
cirrhosis
red color markings from endoscopy
alcohol use
what is EVL
endoscopic variceal ligation
T or F:
NSBBs and EVL showed a decrease in variceal and Gi bleeding with mortality benefit
false, no effect on mortality
primary prophylaxis for variceal bleeding
NSBB or EVL (not in combo tho)
B2 antagonism =
splanchnic vasoconstriction
B1 antagonism=
dec HR and dec CO
3 NSBBs
NPC
3.5 side effects of NSBB
drowsiness/insomnia
bradycardia
hypotension
HR goal for NSBBs
55-60
BP goal for NSBBs (SBP)
SBP > 90
esophageal varices are asymptomatic, how do you visualize them?
endoscopy
5 s/sxs under variceal bleeding clinical presentation
hematemesis
melena
fatigue
lightheaded/dizzy
hypotension
somatostatin analog that vasoconstricts
ocreotide
tx of variceal bleeding:
- octreotide
- _________ prophylaxis
blood transfusions*
antibiotic
what is not recommended for variceal bleeds
PPis
octreotide inhibits release of ____________ resulting in splanchnic ___________ and decreased blood flow
vasodilatory peptides
vasoconstriction
indications of ocrtreotide
acute variceal bleed (not any other types of GI bleeds)
in practice, when do you usually stop octreotide?
24 hours after successful EVL
4 side effects under octreotide
N/V
htn
bradycardia
hyperglycemia
4 things to monitor for octreotide
s/sxs
BP
HR
BG
what is the gold standard for variceal bleeding cessation
EVL
how fast do you want to complete an EVL upon presentation
12 hours
what antibiotic recommended for prophylaxis for variceal bleedign
ceftriaxone
1 side effect ceftriaxone
diarrhea
T or F:
ceftriaxone is renally adjusted in CrCl <50
false dumbass its not renally cleared
duration of ceftriaxone
until hemorrhage resolution (max of 7 days)
secondary prophylaxis for varices
EVL every 1-4 weeks (how tf does this work?)
NSBBs indefinitely
what is the proposed patho of HE
accumulation of ammonia
primary s/sxs of HE
altered mental status and a bunch of other mental shit
first line HE
lactulose
counseling for lactulose
GI side effects, hydrate mucho
what thing under SBP clinical presentation did isaacs say was unique to SBP 10 times?
abdominal pain/ tenderness
diagnosis of SBP
ascitis fluid with >250 cells with PMN
SBP treatment
ceftriaxone again yay + albumin dec mortality
how to dose albumin for SBP
Day 1: 1.5g/kg x 1 (within 6 hours of diagnosis)
Day 3: 1g/kg x 1
SBP secondary prophylaxis
bactrim or cipro and only once a day instead of 2 like normal
what to monitor on bactrim (3)
SCr, electrolytes, CBC
what to monitor on cipro
mental status, CBC, renal function
