Liver, Cirrhosis, Pancrease

Question 1

1. What is the concern for over transfusion with active esophageal bleeding?
2. How should esophageal bleeding patients be managed when they have evidence of coagulopathy ? (INR > 1.5 or Platelets < 50,000) and why ?

Answer 1

1. Overtransfusion Hgb > 10mg//dl —-> more bleeding (more of a concern if they cant get a EGD done within 5 hrs….if not transfuse!!!!)
2. Transfuse with Platelets or FFP because the target INR needs to be < 3 prior to Endoscopy (minimize further bleeding risk with procedure)

Question 2

Name the diagnosis:

1. Jaundice, fever, anorexia, abdominal distention, encephalopathy, muscle weakness AST > ALT ratio > 2, Elevated GTT, Bilirubin, INR but low albumin, fatty liver on US. Dx?
2. Fever, RUQ pain, Nausea, vomiting, Diarrhea? Rx?
3. Fever, RUQ pain, JAUNDICE, Nausea, Vomiting, Diarrhea. Dx? Management?
4. Jaundice, diffuse abdominal pain, AST and ALT > 500 U/L ?

Answer 2

1. Alcoholic Hepatitis
2. Acute Cholecystitis - IVF, Pain medication, Abx, Surgery
3. Acute Cholangitis - IVF, Pain medication, Abx ERCP to retrieve stone.
4. Tylenol Toxicity

Question 3

This is a concern after an attack for Resolved Pancreatitis in patients with persistently Elevated Lipase, Abdominal fullness. Dx? Imaging test Rx?

What if they come infected ?

Answer 3

Pancreatic Pseudocyst

Abdominal CT

Resolve without intervention.

Drain via Percutaneous, Surgical or Endoscopic procedures.

Question 4

Associated with Elevated ALK Phos levels and Pruritus?

Dx?
Rx?

Answer 4

PBC

Ursodeoxycholic Acid

Question 5

Whats the Platelet Transfusion Threshold for Variceal bleeding?

What is important prescribe upon discharge?

What is the Platelet and INR threshold for Paracentesis?

Answer 5

if <50,000 —> Transfuse

Antibiotics for up to 7 days. —-> to prevent SBP

It can be done with INR > 8 and plt count < 19,000

Question 6

What is the management of a Pancreatic Mass?

Answer 6