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PHM 604 > Exam 3 > Flashcards

Exam 3 Flashcards

1
Q

Complications of cirrohosis

A 
ascites
portal HTN
variceal bleeding 
SBP
HE
HRS
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2
Q

SBP stands for

A

spontaneous bacterial peritonitis

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3
Q

HE stands for

A

Hepatic encephalopathy

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4
Q

HRS stands for

A

Hepatorenal syndrome

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5
Q

Scoring for transplant considerations

A

MELD

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6
Q

Scoring for dosage adjustments

A

Child Pugh

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7
Q

Most common complication of cirrohosis

A

ascites

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8
Q

Ascites physical exam

A

full tense bulging abdomen

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9
Q

Diagnosis for portal HTN

A

SAAG ≥ 1.1

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10
Q

Ascites treatment

A

Na2+ restriction 2g/day
Spironolactone 100
Furosemide 40
Large volume paracentesis

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11
Q

Ascites and systolic BP under 90 treatment

A

Midodrine 7.5 TID

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12
Q

AEs of large volume paracentesis

A

drop BP and increase SCr

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13
Q

How to treat increasing SCr in large volume paracentesis

A

More than 5L give IV albumin 25% 8g IV for every liter of fluid removed

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14
Q

TIPS stands for

A

Transjugular intrahepatic portosystemic shunt

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15
Q

What is TIPS in simple terms

A

A stent that connects the portal and hepatic vein to avoid the liver to relieve some of the pressure

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16
Q

TIPS used to treat

A

refractory ascites

refractory variceal bleeding

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17
Q

AEs of TIPS

A

Hepatic encephalopathy

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18
Q

Why do we treat portal HTN

A

to prevent variceal bleeding from developing

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19
Q

How to diagnosis portal HTN

A

EGD and SAAG ≥ 1.1

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20
Q

Treatment for portal HTN

A

Non selective beta blockers (propanolol, nadolol, carvedilol)

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21
Q

Holding parameters for non selective beta blockers for portal HTN

A 
Systolic < 90
diastolic < 60
HR < 60
HRS
refractory ascites
SBP
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22
Q

In cirrhosis you can have normal LFTs

true or false

A

True

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23
Q

How can cirrhotics have normal LFTs

A

they killed all their hepatocytes already

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24
Q

Cirrhosis signs

A

low albumin
high bili
low platelets
high PT INR

25
Q

Acute variceal bleeding caused by

A

portal HTN

26
Q

Treatment for acute variceal bleeding

A 
Supportive care
IV octreotide
EVL
SBP prophylaxis 
once stabilized - non selective beta blockers
27
Q

Supportive treatment for acute variceal bleeding

A

IV fluids
PRBC (Hg=8)
oxygen

28
Q

Octreotide dose in actue variceal bleeding

A

50 mcg bolus then infusion

29
Q

SBP prophylaxis treatment

A

7 days IV Ceftriaxone (3rd gen)

or Cipro if allergic

30
Q

SBP caused by

A

bacterial infection of ascitic fluid enteric gram -

31
Q

Diagnosis of SBP

A

Absolute polymorphonnucleated leukocyte ≥ 250

+ bacterial culture (will still treat if negative)

32
Q

SBP active infection treatment

A

Ceftriaxone or Cefotaxime (Cipro if allergy)

IV for 5 days

possibly IV albumin 25%

33
Q

Why give albumin in SBP active infection

A

SCr > 1
BUN > 30
Bili > 4
any one of these 3

34
Q

Albumin dose in SBP active if needed

A

IV albumin 25%
1.5 g/kg on day 1
1 g/kg on day 3

35
Q

When can you give SBP prophylaxis

A

variceal bleeding (3rd gen 7 days)

or indefinite for patients with history of SBP

or indefinite for patients ascitic protein

36
Q

SAAG

A

albumin in ascitic fluid to serum albumin gradient

37
Q

Indefinite SBP prophylaxis treatment drugs

A

Cipro 250-500 QD

Bactrim DS 1 tablet QD

38
Q

Hepatic encephalopathy causes

A

ammonia toxin buildup for decreased hepatic function and portal systemic shunting

39
Q

Treatment for HE

A

Lactulose + Rifaximin

40
Q

Lactulose acute HE dose

A

25 ml PO q1-2 until 2 loose stools or

300ml retention enema q6-12

41
Q

Lactulose prevention HE dose

A

15-60ml PO q6-12hrs to 2-3 soft BM a day

42
Q

Rifaximin can be given alone to treat HE

True or false

A

False

43
Q

Rifaximin acute HE dose

A

400mg PO q8hrs

44
Q

Rifaximin maintenance

A

550mg POO BID

45
Q

HRS is

A

splanchnic vasodilation secondary to portal HTN

46
Q

HRS mortality rate

A

high

2-4 week survival rate

47
Q

When to give streamline treatment in SBP active

A

after 48-72 hrs

switch just to target

48
Q

How to diagnose HRS

A

cirrhosis with ascites
SCr ≥ 0.3 in 48 hrs or ≥ 50% in baseline in 7 days

No improvement in SCr 2 days after diuretic cessation and IV albumin = HRS

49
Q

How to presenting for variceal bleeding

A

throwing up blood
tachy
low Hg

50
Q

HRS treatment

A

liver transplant

IV NE and IV albumin 1 g/kg/day

51
Q

HE signs

A

falling asleep
not responsive during exam
asterixis

52
Q

High ammonia = severity HE

true or false

A

False

higher ammonia means HE but how high doesn’t mean increased severity

53
Q

HRS treatment if no decrease of SCr in 4 days what should we do

A

d/c therapy and get liver transplant

54
Q

PKPD changes in cirrhosis

A 
Decrease liver blood flow 
loss of hepatocyte function
Decrease albumin production
Decrease renal function when SCr increasd
increased therapeutic response
55
Q

Decrease liver blood flow what should we do

A

impacts high first pass drugs

may need to decrease dose

56
Q

Loss of hepatocyte function

what should we do

A

effect phase I (CYP) more so switch to drug metabolized by phase II

57
Q

Decreased albumin

what should we do

A

decrease dose for heavily protein bound drugs

58
Q

Increased therapeutic response

what should we do

A

BBB more permeabile

decrease dose

PHM 604 (3 decks)

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