Exam 4 - Hepatology Isaacs Flashcards
cirrhosis results in _____ albumin, _____ INR
a. inc; inc
b. dec; dec
c. inc; dec
d. dec; inc
d. dec; inc
how many grams of acetaminophen can result in hepatotoxicity?
8 grams or more
reversal agent for acetaminophen DILI
NAC +/- activated charcoal
NAC indication: based on conc of acetaminophen (> ____ hours after ingestion) and timing since ingestion
4
oral NAC dose (loading and maintenance)
140 mg/kg loading dose followed by 70 mg/kg q4h x 72 hours
_______ is used to confirm diagnosis of cirrhosis
biopsy
what is MELD and what does it predict?
Model for End-Stage Liver Disease, predicts 3 month-mortality risk and used in transplant prioritization
non-pharm ascites sodium restriction
< 2 g/day
avoid which drug class in pts with cirrhosis
NSAIDs
two first line drugs for ascites management; what is the usual dosing ratio?
spironolactone 100: furosemide 40
which class of drugs for ascites inc potassium?
a. spironolactone
b. furosemide
a. spironolactone
we should supplement albumin in pts who had > ____ liters of fluid removed via paracentesis
a. 1
b. 2
c. 5
d. 10
c. 5
replacing albumin in pts who had > 5 L fluid removed via paracentesis
25% albumin IV and give 6-8 g albumin per L removed
DI is a 52 year old male with cirrhosis, who presented to the hospital with tense ascites and is in acute kidney injury (baseline SCr ~1, admission SCr 2.2). Due to the AKI, paracentesis is performed and 8L are removed. How much albumin should be given to DI?
a. Albumin 5% 500 mL IV once
b. Albumin 5% 1 L IV once
c. Albumin 25% 200 mL IV once
d. Albumin 25% 300 mL IV once
c. Albumin 25% 200 mL IV once
(don’t use albumin 5%; replace with 6-8 g/L
8 L * 6 g = 48 g albumin
8 L * 8 g = 64 g albumin
25% of 200 mL = 50 g which is in range
25% of 300 mL = 75 g)
variceal bleeding occurs in pts with _______
cirrhosis
T or F: NSBBs or EVL for variceal bleeding prophylaxis showed dec variceal and GI bleeding, but no mortality benefit
T
two options for primary prophylaxis of variceal bleeding
NSBB or EVL monotherapy (not in combo)
NSBB beta 1 antagonism
a. dec HR, dec CO
b. splanchnic vasoconstriction
a. dec HR, dec CO
NSBB beta 2 antagonism
a. dec HR, dec CO
b. splanchnic vasoconstriction
b. splanchnic vasoconstriction
3 NSBBs for variceal bleeding primary prophylaxis
nadolol
propranolol
carvedilol
(NPC)
NSBBs for primary prophylaxis of variceal bleeds:
adjust dose every ___ days until goals achieved
HR goal ___-___ bpm
SBP > _____ mmHg
3
55-60
90
gold standard to control variceal bleeding
Endoscopic Variceal Ligation (EVL)
tx of variceal bleeding immediately upon presentation (3 things to know; slide 54)
blood transfusions
octreotide
antibiotic prophylaxis
octreotide is recommended for ___-___ days, but is frequently stopped _____ hours after EVL
2-5; 24
primary antibiotic prophylaxis for active variceal bleeding
ceftriaxone of max 7 days
ceftriaxone side effect
diarrhea
T or F: vitamin K is recommended in pts with cirrhosis
F
secondary prophylaxis for varices (2 things)
EVL every 1-4 weeks
NSBBs indefinitely (until decompensated)
primary and secondary prophylaxis for varices: what are the HR and BP goals?
HR: 55-60 bpm
BP: SBP > 90 mmHg
SBP stands for
spontaneous bacterial peritonitis
SBP diagnosis
therapeutic paracentesis; PMNs > 250
does this pt have SBP?
1000 WBCs
30% neutrophils
1000(0.3) = 300. Greater than 250, so they do have SBP
SBP antibiotic tx
ceftriaxone for 5-7 days
_______ has been shown to decrease mortality and AKI/HRS in patients with SBP
-Day 1: _____ g/kg x 1 (within ___ hours of diagnosis)
-Day 3: _____ g/kg x 1
albumin
1.5
6 hours
1
2 antibiotics for SBP secondary prophylaxis
Bactrim
Ciprofloxacin
are antibiotics for SBP secondary prophylaxis dosed once or twice daily?
once daily
recurrence of SBP within 1 year is ____ %
a. 5%
b. 20%
c. 50%
d. 70%
e. 95%
d. 70%
