Liver Disease Lifestyle Mods and Portal HTN

Question 1

What is the underlying cause of most complications in liver failure?

Answer 1

portal hypertension

Question 2

How is portal HTN diagnosis?

Answer 2

hepatic-vein pressure gradient >5mmHg

Question 3

What is usually the first complication of portal HTN?

Answer 3

esophageal varacies

Question 4

What stage do varices develop?

Answer 4

stage 2

Question 5

What is the most lethal acute complication of cirrhosis?

Answer 5

variceal bleed

Question 6

What is treatment for varices?

Answer 6

non-selective beta-blocker

Question 7

Can NSBB be used to prevent portal HTN?

Answer 7

No; treat once varices devlop

Question 8

What NSBB are used to treat portal HTN?

Answer 8

Propranolol
Nadolol
Carvedilol

Question 9

What is the goal is treatment with NSBB?

Answer 9

lower HVPG >20% or max tolerated dose of beta-blocker

Question 10

What needs to be maintained when using max doses of beta-blocker?

Answer 10

HR >50
systolic BP >90 mmHg

Question 11

How does NSBBs work to decrease portal HTN?

Answer 11

Beta-1 blockade: decrease CO
Beta-2 blockade: increase splenic vasoconstriction
- reduces portal inflow and pressure

Question 12

What are common SEs of NSBBs?

Answer 12

1. fatigue
2. hypotension
3. SOB

Question 13

How are active variceal bleeds treated?

Answer 13

Octreotide + band ligand
AND
antibiotics +/- blood transfusion

Question 14

How long should IV vasoactive therapy be used?

Answer 14

2-5 days

Question 15

What agents are used for IV vasoactive therapy?

Answer 15

Octreotide
Terlipressin

Question 16

What is an appropriate level of hemoglobin for blood transfusion?

Answer 16

> 7 but < 9

Question 17

What antibiotics should be used for a variceal bleed?

Answer 17

Ceftriaxone
Quinolones

Question 18

What should be utilized to treat GI bleed?

Answer 18

PPI