Gallbladder Disease and Jaundice Essentials Flashcards
What are the main complications of End Stage Liver Disease?
Portal HTN, Ascites, Varices, Spontaneous Bacterial Peritonitis, Encephalopathy, Malnutrition, Coagulopathy, Thrombocytopenia,
What do you use to treat Portal HTN?
Non-selective beta blocker, oral nitrates, TIPPS, low sodium
How do you reduce pressure in portal HTN?
Non-selective beta blocker
How do you dilate the splanchnic system and make a bigger reservoir?
Oral nitrates
What two drugs are prophylaxis for esophageal varieces?
Non-selective beta blockers and Oral nitrates
What is TIPPS?
Percutaneous procedure done through the jugular down the IVC, into one of the hepatic veins. Then a wire is passed into the portal system (inject contrast to confirm) and this creates a tract though hepatic vein into the portal vein. A metal stent is deployed and creates a tract through which blood doesn’t have to go through hepatocyte to get to IVC.
Why is TIPPS useful?
It decreases pressure, essentially creating esophageal varices but in the liver. Can also do TIPPS for intractable ascites.
What problems are associated with TIPPS?
Can worsen encephalopathy (shunting detoxified blood to the brain), cause fluid shifts and pressure shifts (potential of stealing of blood from systemic system and causing renal insufficiency)
What do you need to remember when treating patients with Portal HTN?
They are often hyponatremic - so do fluid restriction. Loop diuretics (furosemide) + spironolactone does a good job of maintaining potassium.
What do you use to treat encephalopathy caused by End Stage Liver Disease?
Lactulose, Antibiotics, Dietary
How does Lactulose help with encephalopathy?
Lactulose is a sugar that becomes lactic acid in the colon and acidifies stool. The colon can then continue to pump more ammonia into the colon (ammonia is the key toxin in the body -breakdown of protein). It also causes diarrhea which moves bacteria out of the gut and produces less ammonia in the gut. It acts as a trap/sink for bacteria.
How do antibiotics help with encephalopathy?
They decrease bacterial burden (less ammonia produced)
How does diet change encephalopathy?
Big dietary load (legend - not as common as you think) (steak dinner) can exacerbate encephalopathy.
How do you initially manage Acute cholecystitis?
Broad spectrum antibiotics and pain management
What needs to be completed within 96 hours of onset of symptoms in Acute cholecystitis?
Laprascopic Cholecystectomy (90 percent done laprascopically). Serious complications are rare (2.6 percent of cases). Complications include bleeding, abscess formation, bile leak (persistent pain, peritonitis which leads to ERCP procedure to fix), biliary tract injury (clips in wrong spot), bowel injury.
