Cirrhosis

Question 1

cholestasis dt any cause can cause

Answer 1

pruritis

Question 2

6 cholestasis conditions

Answer 2

intrahepatic cholestasis of pregnancy

primary sclerosing cholangitis

malignant biliary tract obstruction

chronic viral hep

nonmalignant biliary tract obstruction

cirrhosis

Question 3

elevated levels of bile acids in the skin act as

Answer 3

pruritogens

Question 4

what are endogenous opioids

Answer 4

opioids produced by the body → elevated in chronic liver dz

Question 5

studies show that pt’s w. cholestatis pruritis have higher serum levels of (2)

Answer 5

LPA (lysophosphatidic acid)

autotaxin

Question 6

1st line tx for cholestatic pruritis

Answer 6

bile acid sequestrant

Question 7

contraindications for bile acid sequestrant (2)

Answer 7

intrahepatic cholestasis of pregnancy

primary biliary cholangitis

Question 8

2 examples of bile acid sequestrants

Answer 8

cholestyramine (Questran)

colestipol (Colestid)

Question 9

2nd line tx for cholestatic pruritis

Answer 9

rifampin (rifampicin)

Question 10

3d line tx for cholestatic pruritis

Answer 10

opioid antagonists

Question 11

vivitrol is an

Answer 11

opioid antagonist

Question 12

last line tx for cholestatic pruritis

Answer 12

sertraline

OR

phenobarbitlol

Question 13

order of tx for cholestatic pruritis

Answer 13

1. bile acid sequestrant
2. rifampin
3. opioid antagonist
4. sertraline OR phenobarbital

Question 14

what class of drug does NOT help for cholestatic pruritis

Answer 14

antihistamines

Question 15

what factors does the MELD use (7)

Answer 15

bilirubin

creatinine

INR

recent dialysis

Na

sex (female)

albumin

Question 16

what value changed on MELD 3.0

Answer 16

Cr cutoff

Question 17

higher MELD scores are associated w. (2)

Answer 17

worse liver dysfxn

higher mortality

Question 18

MELD is used to prioritize

Answer 18

pt’s awaiting liver transplant

Question 19

7 complications of cirrhosis

Answer 19

variceal hemorrhages

ascites

SBP

hepatic encephalopahy

hepatic hydrothorax

HCC

hepatopulmonary syndrome

Question 20

screening for variceal hemorrhages

Answer 20

EGD

Question 21

tx for variceal hemorrhages

Answer 21

band ligation

Question 22

tx for ascites

Answer 22

diuretics

paracentesis

Na restriction

Question 23

specific diuretics and dosing for ascites tx

Answer 23

spironolactone/furosemide 100:40

Question 24

tx for SBP

Answer 24

cefotaxime

Question 25

any pt w. past SBP infxn needs

Answer 25

prophylactic abx

Question 26

tx for hepatic encephalopathy (2)

Answer 26

1. lactulose/lactitol 2. rifamixin

Question 27

tx for hepatic hydrothorax (2)

Answer 27

diuretics Na restriction

Question 28

tx for HCC (2)

Answer 28

surgical resection tranplant

Question 29

tx for hepatopulmonary syndrome (2)

Answer 29

liver transplant long term O2

Question 30

screening for HCC

Answer 30

serial US

Question 31

screening for hepatic encephalopahy

Answer 31

detailed neuro exam and testing

Question 32

what screening tool is used for etoh abuse

Answer 32

CAGE

Question 33

what does CAGE stand for

Answer 33

thought about **c**utting down on your drinking? **a**nnoyed by criticism of your drinking? **g**uilt about drinking? drink as **e**ye-opener in the AM?

Question 34

tx for COPD

Answer 34

tiotropium (spiriva) PLUS short acting rescue inhaler

Question 35

tx for cirrhosis (3)

Answer 35

diuretics +/- paracentesis for ascites edema management