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GI Exam 2 > Management Of Liver Disease > Flashcards

Management Of Liver Disease Flashcards

1
Q

What are 3 lifestyle modifications needed for liver disease?

A
  1. Weight loss in stage 1 and 2 cirrhosis
  2. Alcohol Abstinence
  3. Smoking cessation
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2
Q

What is the underlying cause to most complications with cirrhosis?

A

Portal hypertension

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3
Q

What is the hepatic vein pressure gradient?

A

> 5 mmHg

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4
Q

When is the HVPG significant?

A

> 10 mmHg

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5
Q

What is the first complication that is seen with portal hypertension?

A

Esophageal varices

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6
Q

True or false: esophageal varices screening is recommended for all patients with cirrhosis

A

True

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7
Q

When do varices develop?

A

In stage 2 cirrhosis

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8
Q

True or false: There is primary prophylaxis for esophageal varices for all patients with cirrhosis

A

False

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9
Q

What drug class is used for the treatment of varices?

A

Non-selective beta blockers

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10
Q

When should you treat varices?

A

Once they develop

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11
Q

What are the 3 non-selective beta blockers that need to be used to treat varices?

A
  1. Propranolol
  2. Nadalol
  3. Carvedilol
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12
Q

What is the goal for HVPG when using a beta blocker?

A

Lower HVPG > 20% or maximum tolerated dose of a beta blocker

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13
Q

What is the most effective beta blocker to use for HVPG?

A

Carvedilol

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14
Q

What HR and blood pressure is needed to maintain the maximum dose of the beta blockers?

A
  1. HR: > 50 bpm
  2. BP: > 90 mmHg
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15
Q

What do the beta blockers decrease?

A

Cardiac output

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16
Q

What do the beta blockers increase?

A

Splanchnic vasoconstriction

17
Q

What are 3 common ADRs seen with beta blockers?

A
  1. Fatigue
  2. Hypotension
  3. SOB
18
Q

What drug is used to treat an esophageal bleed?

A

Octreotide

19
Q

What is the primary treatment for a variceal bleed?

A

Band ligation

20
Q

What are 2 additional therapies that may be needed for a variceal bleed?

A
  1. Antibiotics
  2. Blood transfusion
21
Q

How long is octreotide therapy used?

A

For 2-5 days

22
Q

What do the intravenous vasoactive meds reduce? 2

A

1 Splanchnic blood flow
2. Portal hypertension

23
Q

What drug recently got FDA approved to treat variceal bleeds?

A

Terlipressin

24
Q

For blood transfusions, what should you maintain the hemoglobin at?

A

> 7 g/dL but <9 g/dL

25
Q

What is the goal for blood transfusions?

A
  1. Prevent hypotension
  2. Prevent hepatorenal syndrome
26
Q

What antibiotics can be used for variceal bleeds?

A
  1. Ceftriaxone
  2. Quinolones
27
Q

True or false: the antibiotics are used for patients with an active bleed only

A

True

28
Q

What other drug class can be can be utilized initially for an active bleed?

A

PPIs

GI Exam 2 (11 decks)

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