Management Of Liver Disease Flashcards
What are 3 lifestyle modifications needed for liver disease?
- Weight loss in stage 1 and 2 cirrhosis
- Alcohol Abstinence
- Smoking cessation
What is the underlying cause to most complications with cirrhosis?
Portal hypertension
What is the hepatic vein pressure gradient?
> 5 mmHg
When is the HVPG significant?
> 10 mmHg
What is the first complication that is seen with portal hypertension?
Esophageal varices
True or false: esophageal varices screening is recommended for all patients with cirrhosis
True
When do varices develop?
In stage 2 cirrhosis
True or false: There is primary prophylaxis for esophageal varices for all patients with cirrhosis
False
What drug class is used for the treatment of varices?
Non-selective beta blockers
When should you treat varices?
Once they develop
What are the 3 non-selective beta blockers that need to be used to treat varices?
- Propranolol
- Nadalol
- Carvedilol
What is the goal for HVPG when using a beta blocker?
Lower HVPG > 20% or maximum tolerated dose of a beta blocker
What is the most effective beta blocker to use for HVPG?
Carvedilol
What HR and blood pressure is needed to maintain the maximum dose of the beta blockers?
- HR: > 50 bpm
- BP: > 90 mmHg
What do the beta blockers decrease?
Cardiac output
What do the beta blockers increase?
Splanchnic vasoconstriction
What are 3 common ADRs seen with beta blockers?
- Fatigue
- Hypotension
- SOB
What drug is used to treat an esophageal bleed?
Octreotide
What is the primary treatment for a variceal bleed?
Band ligation
What are 2 additional therapies that may be needed for a variceal bleed?
- Antibiotics
- Blood transfusion
How long is octreotide therapy used?
For 2-5 days
What do the intravenous vasoactive meds reduce? 2
1 Splanchnic blood flow
2. Portal hypertension
What drug recently got FDA approved to treat variceal bleeds?
Terlipressin
For blood transfusions, what should you maintain the hemoglobin at?
> 7 g/dL but <9 g/dL
What is the goal for blood transfusions?
- Prevent hypotension
- Prevent hepatorenal syndrome
What antibiotics can be used for variceal bleeds?
- Ceftriaxone
- Quinolones
True or false: the antibiotics are used for patients with an active bleed only
True
What other drug class can be can be utilized initially for an active bleed?
PPIs
