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Flashcards in Conrad Fisher's Liver Deck (23):
1

What drug should be used to treat the edema and ascites caused by cirrhosis?

spidonolactone (or aldactone)

2

What should be done for a cirrhotic pt who is bleeding?

fresh frozen plasma

3

What is the best acute treatment for bleeding esophageal varices?

banding

4

What kind of drug should be given as prophylaxis against future bleeding from esophageal varices?

β-blockers

5

What should be given for hepatic encephalopathy?

lactulose

6

How does lactulose treat hepatic encephalopathy?

causes ammonia to be excreted from the colon

7

Why do pts w/ cirrhosis develop thrombocytopenia?

portal htn --> splenomegaly

8

What are the criteria for transfusing plts in cirrhotic pts?

bleeding and plt < 50,000

9

What is the SAAG?

Serum-Ascites Albumin Gradient (difference)

10

What is the SAAG in portal htn?

>1.1

11

What if the SAAG is less than 1.1?

the ascites is due to malignancy or some other cause aside from portal htn

12

Pt. has peritonitis. The SAAG is >1.1. What kind of peritonitis is this?

spontaneous bacterial peritonitis (SBP)

13

What are the criteria for spontaneous bacterial peritonitis, other than SAAG >1.1?

>500 WBC, >250 NΦs/μL

14

What are 4 of the most common organisms responsible for spontaneous bacterial peritonitis?

E. coli, Klebsiellla, Pneumococcus, and Enterococcus

15

What is the best drug for SBP (if caused by the usual suspects)?

Cefotaxime

16

Why isn't ceftriaxone as good as cefotaxime for cirrhotic pts w/ SBP, even though it has the same spectrum of activity?

metabolized by liver
(cefotaxime renally metabolized)

17

Itchy, middle-aged female w/ elevated alk phos. Suspect what?

primary biliary cirrhosis

18

What is the etiology of primary biliary cirrhosis?

Abs against biliary ducts

19

What special Ab is seen in primary biliary cirrhosis?

anti-mitochondrial

20

What is the most accurate test for most causes and effects of cirrhosis?

liver biopsy

21

What is the most accurate test for primary sclerosing cholangitis?

ERCP

22

What 2 drugs are best for treating primary sclerosing cholangitis or primary biliary cirrhosis?

cholestyramine or ursodeoxycholic acid

23

What is the mechanism of cholestyramine and ursodeoxycholic acid in treating primary biliary disease?

bind cholesterol and bile acids for excretion