Exam 3

Question 1

Complications of cirrohosis

Answer 1

ascites
portal HTN
variceal bleeding 
SBP
HE
HRS

Question 2

SBP stands for

Answer 2

spontaneous bacterial peritonitis

Question 3

HE stands for

Answer 3

Hepatic encephalopathy

Question 4

HRS stands for

Answer 4

Hepatorenal syndrome

Question 5

Scoring for transplant considerations

Answer 5

MELD

Question 6

Scoring for dosage adjustments

Answer 6

Child Pugh

Question 7

Most common complication of cirrohosis

Answer 7

ascites

Question 8

Ascites physical exam

Answer 8

full tense bulging abdomen

Question 9

Diagnosis for portal HTN

Answer 9

SAAG ≥ 1.1

Question 10

Ascites treatment

Answer 10

Na2+ restriction 2g/day
Spironolactone 100
Furosemide 40
Large volume paracentesis

Question 11

Ascites and systolic BP under 90 treatment

Answer 11

Midodrine 7.5 TID

Question 12

AEs of large volume paracentesis

Answer 12

drop BP and increase SCr

Question 13

How to treat increasing SCr in large volume paracentesis

Answer 13

More than 5L give IV albumin 25% 8g IV for every liter of fluid removed

Question 14

TIPS stands for

Answer 14

Transjugular intrahepatic portosystemic shunt

Question 15

What is TIPS in simple terms

Answer 15

A stent that connects the portal and hepatic vein to avoid the liver to relieve some of the pressure

Question 16

TIPS used to treat

Answer 16

refractory ascites

refractory variceal bleeding

Question 17

AEs of TIPS

Answer 17

Hepatic encephalopathy

Question 18

Why do we treat portal HTN

Answer 18

to prevent variceal bleeding from developing

Question 19

How to diagnosis portal HTN

Answer 19

EGD and SAAG ≥ 1.1

Question 20

Treatment for portal HTN

Answer 20

Non selective beta blockers (propanolol, nadolol, carvedilol)

Question 21

Holding parameters for non selective beta blockers for portal HTN

Answer 21

Systolic < 90
diastolic < 60
HR < 60
HRS
refractory ascites
SBP

Question 22

In cirrhosis you can have normal LFTs

true or false

Answer 22

True

Question 23

How can cirrhotics have normal LFTs

Answer 23

they killed all their hepatocytes already

Question 24

Cirrhosis signs

Answer 24

low albumin
high bili
low platelets
high PT INR

Question 25

Acute variceal bleeding caused by

Answer 25

portal HTN

Question 26

Treatment for acute variceal bleeding

Answer 26

``` Supportive care IV octreotide EVL SBP prophylaxis once stabilized - non selective beta blockers ```

Question 27

Supportive treatment for acute variceal bleeding

Answer 27

IV fluids PRBC (Hg=8) oxygen

Question 28

Octreotide dose in actue variceal bleeding

Answer 28

50 mcg bolus then infusion

Question 29

SBP prophylaxis treatment

Answer 29

7 days IV Ceftriaxone (3rd gen) or Cipro if allergic

Question 30

SBP caused by

Answer 30

bacterial infection of ascitic fluid enteric gram -

Question 31

Diagnosis of SBP

Answer 31

Absolute polymorphonnucleated leukocyte ≥ 250 + bacterial culture (will still treat if negative)

Question 32

SBP active infection treatment

Answer 32

Ceftriaxone or Cefotaxime (Cipro if allergy) IV for 5 days possibly IV albumin 25%

Question 33

Why give albumin in SBP active infection

Answer 33

SCr > 1 BUN > 30 Bili > 4 any one of these 3

Question 34

Albumin dose in SBP active if needed

Answer 34

IV albumin 25% 1.5 g/kg on day 1 1 g/kg on day 3

Question 35

When can you give SBP prophylaxis

Answer 35

variceal bleeding (3rd gen 7 days) or indefinite for patients with history of SBP or indefinite for patients ascitic protein

Question 36

SAAG

Answer 36

albumin in ascitic fluid to serum albumin gradient

Question 37

Indefinite SBP prophylaxis treatment drugs

Answer 37

Cipro 250-500 QD | Bactrim DS 1 tablet QD

Question 38

Hepatic encephalopathy causes

Answer 38

ammonia toxin buildup for decreased hepatic function and portal systemic shunting

Question 39

Treatment for HE

Answer 39

Lactulose + Rifaximin

Question 40

Lactulose acute HE dose

Answer 40

25 ml PO q1-2 until 2 loose stools or 300ml retention enema q6-12

Question 41

Lactulose prevention HE dose

Answer 41

15-60ml PO q6-12hrs to 2-3 soft BM a day

Question 42

Rifaximin can be given alone to treat HE True or false

Answer 42

False

Question 43

Rifaximin acute HE dose

Answer 43

400mg PO q8hrs

Question 44

Rifaximin maintenance

Answer 44

550mg POO BID

Question 45

HRS is

Answer 45

splanchnic vasodilation secondary to portal HTN

Question 46

HRS mortality rate

Answer 46

high | 2-4 week survival rate

Question 47

When to give streamline treatment in SBP active

Answer 47

after 48-72 hrs | switch just to target

Question 48

How to diagnose HRS

Answer 48

cirrhosis with ascites SCr ≥ 0.3 in 48 hrs or ≥ 50% in baseline in 7 days No improvement in SCr 2 days after diuretic cessation and IV albumin = HRS

Question 49

How to presenting for variceal bleeding

Answer 49

throwing up blood tachy low Hg

Question 50

HRS treatment

Answer 50

liver transplant | IV NE and IV albumin 1 g/kg/day

Question 51

HE signs

Answer 51

falling asleep not responsive during exam asterixis

Question 52

High ammonia = severity HE true or false

Answer 52

False higher ammonia means HE but how high doesn't mean increased severity

Question 53

HRS treatment if no decrease of SCr in 4 days what should we do

Answer 53

d/c therapy and get liver transplant

Question 54

PKPD changes in cirrhosis

Answer 54

``` Decrease liver blood flow loss of hepatocyte function Decrease albumin production Decrease renal function when SCr increasd increased therapeutic response ```

Question 55

Decrease liver blood flow what should we do

Answer 55

impacts high first pass drugs | may need to decrease dose

Question 56

Loss of hepatocyte function | what should we do

Answer 56

effect phase I (CYP) more so switch to drug metabolized by phase II

Question 57

Decreased albumin | what should we do

Answer 57

decrease dose for heavily protein bound drugs

Question 58

Increased therapeutic response | what should we do

Answer 58

BBB more permeabile | decrease dose