liver therapeutics Flashcards
labs indicative of cirrhosis
- decreased platelets
- elevated pt/INR
- elevated bilirubin
- decreased albumin
- normal or elevated AST/ALT
clinically significant portal HTN value
> = 10 mmHg
portal HTN greater than 12 puts you at risk for what
gastroesophageal hemorrhage
characteristics of compensated cirrhosis
- mild to clinically significant portal HTN
- varices
characteristics of decompensated cirrhosis
- ascites
- variceal hemorrhage
- hepatic encephalopathy
characteristics of late decompesated cirrhosis
- refractory ascites
- recurrent variceal hemorrhage
- recurrent hepatic encephalopathy
- hepatorenal syndrome
- jaundice
child-pugh grade scale
Grade A <7
Grade B 7-9
Grade C 10-15
child-pugh point system
from 1-3
2 point criteria: bilirubin = 2-3 albumin = 2.8-3.5 (lower is worse) mild ascites HE grade 1 and 2 PT wave 4-6 seconds
important counseling points for cirrhosis
- stop drinking alcohol
- lose weight if NASH is present
- discontinue NSAIDs
most common complication of cirrhosis
ascites
goals of ascites treatment
- control ascites
- prevent dyspnea
- prevent abdominal pain and distention
- prevent SBP and hepatorenal syndrome
treatment for ascites
- spironolactone and furosemide (together is best)
- if they can only handle one spironolactone is better
- paracentesis
- sodium restriction
ratio for spironolatone/furosemide dosing
100:40 mg up to 400/160
which diuretic do you avoid in ascites
HCTZ
paracentesis
drawing fluid straight out of abdomen for ascites
what is required to do if over 5L of ascitic fluid is removed
6-8g/L of albumin
refractory ascites
fluid overload is unresponsive to Na restriction and diuretics or occurs rapidly after parcentesis
treatment for refractory ascites
- add midodrine TID to diuretics
- liver transplantation
- TIPS
TIPS
stent to help flow through the liver
important lab value to consider when using spironolactone and furosemide
potassium
spontaneous bacterial peritonitis(SBP) incidence
10-20%
recurrence up to 70%
risk factors for SBP
- variceal hemorrhage
- prior SBP
- ascitic fluid protein conc. < 1-1.5
- PPI use
presentation of SBP
- fever
- abdominal pain
- encephalopathy
- renal failure
- acidosis
- leukocytosis
SBP diagnosis
- ascitic fluid PMN >250
- ascitic fluid culture