OnlineMedEd: Intern Content - "Cirrhosis III"

Question 1

Acute decompensation in cirrhosis is likely one of three things: ______________.

Answer 1

fluid imbalance (third spacing), infection, and GI bleed

Question 2

What should you order in managing and diagnosing a decompensated cirrhotic?

Answer 2

• Fluid imbalance: albumin
• Infectious workup: broad-spectrum antibiotics, culture of urine/blood/ascites
• Bleeding: CBC, DRE
• Meds: rifaximin, lactulose, zinc

Question 3

You can be transplanted at a MELD of __________.

Answer 3

15 or greater (though generally it doesn’t happen until ~32 in most cases)

Question 4

MELD is calculated with _____________.

Answer 4

total bilirubin, INR, and creatinine (TIC)

Question 5

Hepatorenal syndrome is basically diagnosed by _____________.

Answer 5

elevated creatinine in a person with cirrhosis (AKI in a cirrhotic) that does not respond to fluid, has a negative UA and US, and is not due to infection or bleeding

Question 6

What creatinine parameters are used to diagnose HRS?

Answer 6

Doubling in 2 weeks (2x2)

Question 7

These two medicines are given in those with HRS: ______________.

Answer 7

octreotide and midodrine

Question 8

Which type of HRS is worse?

Answer 8

Type 1

Type 2 is more insidious and has a better prognosis.