Liver Disease and Cirrhosis Flashcards
Cirrhosis
Irreversible scarring (fibrosis) of the liver. leading to impaired blood flow to the liver.
as a reflex increasing blood pressure can lead to Portal HTN, Varices, ascites, and hepatic encepholapathy (Increased BUN)
Drug-induced Liver Injury
Stop drugs when AST/ALT are above 3x the normal limit
AVOID NSAIDs leading to acute decompensation, including bleeding
Alcoholic Liver Disease
Can lead to Wernickes and Korsakoff syndrome due to lack of vit b1
Proper nutrition is essential to helping the liver recover ex.. Znc and Thiamine
Varices
Enlarged veins in the lower part of the stomach
Txt Octreotide and non-selective BB
Octreotide
SandoSTATIN
infusion should be used for 2-5 days
Vasopressin
Vasostrict
Antidiuretic hormone
Nadolol
Brand and BBW
Corgard
BBW: Do not abruptly stop. Taper.
CI: Caution in pt with asthma or COPD
Propanolol
Brand and BBW
Inderal, InnoPran
BBW: Do not abruptly stop. Taper.
CI: Caution in pt with asthma or COPD
Hepatic Encephalopathy
Changes in thinking, confusion, forgetfulness, stinky breath
Results from a accumulation of gut-derived nitrogenous substances in the blood (ammonia)
Lactulose
Brand, Use, SE
Generalac, Contulose, Enulose, Kristalose
1st line for acute and chronic (prevention) therapy
SE: Flatulence, diarrhea, dyspepsia, stomach discomfort
Rifaximin
Xifaxan
Ascities
Txt: Spironolactone +/- Furosemide (Lasix Ineffective as monotherapy)
Ratio if given together: is 40mg of lasix to 100mg of aldactone
Spironolactone can be increased up to 400mg in this setting.
Pt with ascities and cirrhosis should be considered for a liver transplant.
SBP
Caused by an infection in the ascitic fluid by Streptococci and Enteric Gram -
Txt: Ceftriaxone.
2nd prophy: Norfloxacin or bactrim
Hepatorenal syndrome
Failure of the kidneys due to cirrhosis.
