Hepatology Flashcards
What markers are elevated in acute liver injury?
AST, ALT, Alk Phos, Bilirubin are elevated
What markers are changed in chronic liver disease?
Albumin and thrombocytopenia are decreased
Bilirubin, INR are increased
What is the treatment for ascites?
1st line: 100 mg Spironolactone/ 40 mg furosemide
2nd line: Paracentesis
What medication should be avoided in patients with cirrhosis?
NSAIDs
-causes fluid retention
How do you calculate giving albumin to a patient who underwent paracentesis?
-if more than 5 L of fluid has been removed
give 6-8 grams of 25% albumin per liter removed
25%/ 100 mL x mL amt = total amt
When is prophylaxis for esophageal varices indicated?
in window of moderate disease (EV > 5 mm
-either NSBB or EVL (banding)
-nadolol, propranolol, carvedilol
How is active variceal bleeding managed?
EVL - gold standard
-blood transfusion if Hgb > 7
-octreotide until EVL can happen
-antiobiotic prophylaxis (Ceftriaxone)
How is spontaneous bacterial peritonitis diagnosed?
therapeutic paracentesis -small amt of fluid
diagnosis criteria includes > 250 cells of PMN leukocytes
PMNs = WBC from fluid x % neutrophils
What is the treatment for SBP?
ceftriaxone
5-7 days
-albumin on day 1 & 3
What is indicated for secondary prophylaxis for SBP?
SM-TMP (Bactrim DS) daily or ciprofloxacin
what metabolism alterations occur in liver insufficiency?
-decreased metabolism and activation of drugs in cirrhosis
-increased free drug concentration in highly protein bound drugs
