LIVER Flashcards
transmission route for hep A,E
A, E - faecal oral contamination
transmission route for hep B,C
- blood and body fluids
- parenteral
- perinatal
- sexual
transmission route for hep D
coinfection with hep B
side effects of interferon alfa for tx of chronic hepatitis b (list 4)
bone marrow suppression
flu-like sx
gi (nausea, abdominal pain, diarrhoea)
neuropsychiatric disorders
goals of therapy of hep b vs hep c
hep b: achieve hbv viral suppression, prevent disease progression to liver cirrhosis and cancer
hep c: eradicate hcv infection
examples ofc direct acting antivirals for hep c and duration of tx
grazoprevir, ledipasvir. usually need at least 2 drugs on different targets for 8-12 weeks
which labs are elevated in hepatocellular vs cholestatic injury
hepatocellular: ALT, AST
cholestatic: ALP, GGT, bilirubin
what is the ALT/AST ratio indicative of
more than 2 > alcoholic liver disease
list 5 complications of cirrhosis
- portal hypertension and varices, variceal bleed
- ascites
- infection
- encephalopathy
- hcc
why does ascites occur (4 points)
- portal hypertension > increased hydrostatic pressure
- decreased synthesis of albumin > lowered intravascular oncotic pressure
- reduced aldosterone metabolism in liver
- splanchnic vasodilatation
fluid shifts out of portal circulation into peritoneal cavity
therapy goals of propranolol and nadolol
55-60bpm and sbp >90
variceal bleeding what 2 agents are needed
- vasoactive therapy
(eg. somatostatin/terlipressin) - antibiotics to cover general GI gram negative pathogens (ceftriaxone)
what is the ratio of furosemide to spironolactone
40:100
when to fluid restrict in ascites
na less than 125
how much sodium to restrict a day
2g
what meds to avoid in ascites
nsaids, acei, arb
Diet for hep enceph
protein restriction to 1.5g/kg/day
target of lactulose in hep enceph
2 to 3 soft stools per day
alternative to lactulose for hep enceph
rifaximin 550mg bd
difference between NAFLD vs NASH
NAFL: no evidence of hepatocellular injury. not due to alcohol
NASH: presence of inflammation and hepatocellular injury, might progress to cirrhosis and liver failure
how much alcohol consumption is considered significant
> 21 standard drinks in men , >14 standard drinks in women per week
