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Infectious Disease > Liver disease > Flashcards

Liver disease Flashcards

1
Q

symptoms of liver disease

A

N/V/D; loss of appetite; malaise; dark urine; yellow skin/eyes; pale colored stools; right upper quadrant pain; fatigue

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2
Q

when looking at the labs of a patient with liver disease you would suspect all of them to be increasing except

A

albumin (albumin decreases in liver failure)

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3
Q

child pugh and model for end stage liver disease (MELD) measure what

A

severity of liver disease

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4
Q

what natural product can be given for liver health

A

milk thistle

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5
Q

what is the most common type of drug induced liver disease

A

alcoholic liver disease

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6
Q

what nutrition must be provided to patients suffering from Alcoholic liver disease

A

thiamine (b1) and folic acid

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7
Q

what are the complications of liver disease

A

hepatic encephalopathy; portal hypertension; variceal bleeding; ascites

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8
Q

portal hypertension can cause what complications

A

variceal bleeding; ascites; hepatic encephalopathy

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9
Q

what can be given to treat/prevent portal hypertension

A

propranolol or nadolol (non selective beta blockers) variceal ligation

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10
Q

what is the goal HR when treating portal hypertension

A

55 to 66BPM

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11
Q

contraindications to using non selective beta blockers

A

2nd or 3rd degree block; respiratory issues; sick sinus syndrome

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12
Q

what are the side effects of non selective beta blockers

A

lightheadedness; shortness of breath; dizziness

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13
Q

after making sure the patient is hemodynamically stabilized what agents can be given for variceal bleeding

A

octreotide or vasopressin

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14
Q

why is octreotide preferred over vasopressin

A

selective for splanchnic vessels vasopressin is non selective

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15
Q

what surgical interventions can be done for variceal bleeding

A

shunts; balloon tamponade

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16
Q

how long is octreotide given

A

5 days

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17
Q

how long is vasopressin given

A

24 hours max

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18
Q

pitressin

A

vasopressin

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19
Q

what is usually given along with vasopressin

A

IV nitroglycerin

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20
Q

vasopressin is an analog of what hormone

A

ADH

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21
Q

symptoms of hepatic encephalopathy

A

musty odor (breath/urine) loss of small hand movement (hand writing) altered mental status

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22
Q

the symptoms of hepatic encephalopathy are due to accumulation of ____ in the blood

A

ammonia; glutamate

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23
Q

what are the dietary restrictions for hepatic encephalopathy

A

protein intake 1 to 1.5 g/kg (fish and dairy preferred source due to lower calorie:nitrogen) BCAA (leucine isoleucine valine) favored.

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24
Q

what drugs are given for hepatic encephalopathy

A

lactulose (1st line) rifaximin (2nd line) metronidazole neomycin zinc

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25
Q

how does lactulose work

A

prevents bacteria production of ammonia and leeches ammonia into colon for excretion

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26
Q

how do the antibiotics used in hepatic encephalopathy work

A

decrease bacterial ammonia production (inhibit urease producing bacteria)

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27
Q

what probiotics can be used in hepatic encephalopathy

A

lactobacilli; lactococci; bifidobacteria

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28
Q

what dose of Zinc can be given for hepatic encephalopathy

A

220 mg BID

29
Q

lactulose treatment and prevention dose is titrated to?

A

treatment 2 to 3 bowel movements

30
Q

prevention 2

A

4 bowel movements

31
Q

lactulose side effects

A

flatulence; abdominal pain; diarrhea

32
Q

neomycin is not used long term due to

A

ototoxicity; nephrotoxic; breathing problems;

33
Q

metronidazole is not used long term due to

A

peripheral neuropathy

34
Q

rifaximin side effects

A

peripheral edema; ascites; flatulence

35
Q

spontaneous bacterial peritonitis and hepatorenal syndrome can result from

A

ascites

36
Q

a patient with ascites will present with

A

abdominal distention

37
Q

how do you manage ascites

A

< 2 g sodium per day

38
Q

furosemide and spironolactone 40 mg to 100 mg (always in that ratio)

A

furosemide and spironolactone 40 mg to 100 mg (always in that ratio)

39
Q

fluid restriction if serum Na is < 120 mEq

A

fluid restriction if serum Na is < 120 mEq

40
Q

when treating ascites with diuretic therapy how much fluid do you try to remove per day

A

0.5 kg/day MAX

41
Q

what agents should you avoid in ascites

A

NSAIDs; Ibuprofen ( sodium retention)

42
Q

luid restriction in ascites only for what patients

A

symptomatic severe hyponatremia serum na < 120 mEq

43
Q

which form of hepatitis is: self limiting; does not lead to chronic infection

A

Hep A

44
Q

which form of hepatitis is: transferred via fecal oral route (contaminated food)

A

Hep A

45
Q

Havrix; Vaqta are vaccines for

A

Hep A

46
Q

what are risk factors of Hep A

A

homosexual; prositutes; infected animals; IV drug useres

47
Q

what is the vaccine schedule for hep B

A

0; 1; 6 months when using Engerix B

48
Q

Engerix B is the vaccine for

A

Hep B

49
Q

Recombivax HB is the vaccine for

A

Hep B

50
Q

which form of hepatitis is: silent until chronic disease emerges

A

hep C

51
Q

how is Hep C primarily transmitted in the US

A

iv drug use

52
Q

what are the genotypes of Hep C and how long do you treat

A

type 1 (48 weeks) type 2&3 (24 weeks)

53
Q

pegylated interferon has what added to it

A

polyethylene glycol (enhances half life)

54
Q

interferon black box warning

A

may worsen autoimmune; infectious; ischemic; or neuropsychiatric disorders

55
Q

what side effect will all patients experience when taking interferons and (how do you treat it and how long does it last)

A

flu like symptoms (pretreat with APAP or antihistamine can last up to 24 hours)

56
Q

interferon should be withheld when

A

ANC < 500 or platelets < 25;000

57
Q

where are interferons injected

A

SQ into abdomen thigh or upper arms

58
Q

ribavirin treats

A

hep c only

59
Q

when should you check for early viral response when a patient is on ribavirin

A

by week 12 (stop if no early viral response)

60
Q

ribavirin is not recommended at a CrCl of

A

< 50

61
Q

what is the black box warning for ribavirin

A

teratogenic; hemolytic anemia

62
Q

Contraindications to ribavirin

A

Pregnancy; CrCl<8.5g/dl

63
Q

ribavirin side effects

A

hemolytic anemia; worsen cardiac issues; insomnia; anorexia; increased uric acid

64
Q

ribavirin is pregnancy category

A

X

65
Q

how long should patients be using 2 forms of contraception when on ribavirin

A

throughout treatment and 6 months following

66
Q

do not use ribavirin with

A

didanosine (risk of fatal hepatic failure; peripheral neuropathy; pancreatitis)

67
Q

ribavirin may increase levels of

A

NRTI

68
Q

what protease inhibitors treat Hep C

A

bocepavir (Victrelis); Telaprevir (Incivek); Simeprevir (Olysio)

69
Q

What dose riba mean

A

R-renal CrCl<50 = CI; I- Interferon must be used; B-birth defects; 2 forms of BC must be used during & 6 months after; A- Anemia; hemolytic

Infectious Disease (7 decks)

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