Hepatology

Question 1

SBP - Monitoring

Answer 1

S/Sx infection, SCr

Question 2

HE - When to treat?

Answer 2

Confusion +/- inc ammonia (rule out other causes)

Question 3

Esophageal Varices - Monitoring

Answer 3

S/Sx bleeding, HR (goal 55-60), BP (goal >90mmHg)

Question 4

Esophageal Varices - 1st Line Tx

Answer 4

+/- Transfusion + Octreotide + Ceftriaxone + EVL

Question 5

Esophageal Varices - When to treat?

Answer 5

Active variceal hemorrhage (VH)

Question 6

HE - When to use PTx

Answer 6

Secondary: after occurrence of HE
(no primary prevention)

Question 7

Esophageal Varices - 1st line PTx

Answer 7

NSBBs or EVL

Question 8

SBP - When to treat?

Answer 8

Confirmed positive culture OR PMNs >250k

Question 9

SBP - 1st Line Tx

Answer 9

Ceftriaxone + albumin day 1 and 3

Question 10

HE - Monitoring

Answer 10

BMs, mental status

Question 11

Ascites - When to treat?

Answer 11

Ascites present (Abd distention, abd pain, SOB, nausea)

Question 12

Ascites - 1st Line Tx

Answer 12

Spironolactone Furosemide (100mg:40mg)
- Max 400mg:160mg
- spiro best if need MonoTx

Question 13

HE - 1st Line Tx

Answer 13

Lactulose (target ≥2 BMs/day)

Question 14

HE - 1st Line PTx

Answer 14

Lactulose

Question 15

Ascites - Prophylaxis

Answer 15

No Primary Prevention
- Secondary/Treatment: aimed at preventing need for paracentesis

Question 16

SBP - When to use PTx

Answer 16

• Primary: active VH
• Secondary: after, SBP, indefinite Tx

Question 17

SBP - 1st Line PTx

Answer 17

Bactrim QD
- AE: AKI, photosensitivity, inc K, dec Na, Stevens Johnson)

Question 18

Ascites - Monitoring

Answer 18

S/Sx ascites, SCr, K

Question 19

Esophageal Varices - When to use PTx

Answer 19

Secondary: after VH, indefinite as long as BP tolerates
- (don’t need to know primary)

Question 20

Ascites - 2nd Line Tx

Answer 20

Paracentesis
- admin 6-8g Albumin per liter removed (if >5L removed)