Firecracker/Step Up Cirrhosis, Dyspnea Flashcards
1
Q
Cirrhosis pathology
A
diffuse, irreversible
firbosis, necrosis, nodules
2
Q
Cirrhosis - most common causes
A
Hep C > Alcohol > NAFLD > Hep B
3
Q
Cirrhosis - less common causes
A
Autoimmune, PBC, PSC, Wilson’s Disease, Hematochromatosis, alpha 1 antitrypsin def, drugs
4
Q
Findings in Cirrhosis
A
Jaundice, Ascites, Hepatic Encephalopathy, Asterixis
Palmary erythema, spider angiomatas, gynecomastia
caput medua
5
Q
Compensated cirrhosis
A
fatigue, wt loss, weakness
6
Q
Decompensated cirrhosis
A
ascites, edema
confusion, pruritis
hematemesis, melena
7
Q
liver biopsy for cirrhosis
A
presence of fibrosis
regenerating hepatic nodules
decreased number of septa
8
Q
ultrasound in cirrhosis
A
assess countour of liver
impedeance of blood flow
amount of ascites
9
Q
Severe Complications of cirrhosis
A
SBP, varices
hepatorenal/hepatopulmonary syndrome
portal vein thrombosis, cardiomyopathy, hepatic encephalopathy
10
Q
Treatments for Cirrhosis
A
beta blockers
lactulose
TIPS
11
Q
hepatic congestion can occur secondary to
A
right sided heart failure
constrictive pericarditis
12
Q
treatment of varices
A
IV antibiotics
IV octreotide for 3-5 d
beta blockers
endoscopic treatment
13
Q
albumin in cirrhosis
A
hypoalbuminemia = reduced oncotic pressure
14
Q
SAAG > 1.1
A
portal HTN likely
15
Q
fetor hepaticus
A
musty odor of breath
associated with hepatic encephalopathy
16
Q
SBP most common causes
A
e coli
klebsiella
s. pneumonia
17
Q
how to treat coagulopathy in cirrhosis
A
FFP (not vit k)
18
Q
ascites usually found in
A
portal htn/increased hydrostatic pressure
hypoalbuminemia
malignacies - ovarian
infections - tb
19
Q
clinical presentation of ascites
A
abdominal swelling and wt gain
SOB
20
Q
physical exam for ascites
A
bulging flanks
fluid waves
shifting dullness
21
Q
evaluation of ascitic fluid
A
apperance
albumin, total protein
cell count, cell culture
22
Q
causes of portal htn with SAAG > 1.1
A
Budd-Chiari
CHF
constrictive pericarditis
23
Q
SAAG < 1.1
A
nephrotic syndrome
cancer
24
Q
complications of ascites
A
SBP
hepatic hydrothorax
25
treatment of ascites
sodium restriction
diurectics - furosemide, spironolactone
beta blocker
26
alcoholic progression of liver disease
fatty steatosis -->
alcoholic hepatitis -->
liver cirrhosis/fibrosis
27
alcoholic liver disease liver biopsy shows
Mallory bodies
steatosis
fibrosis
28
Mallory bodies
eosinophilic hyaline inclusion bodies
29
steatosis
fatty deposion
30
LFTs in alcoholic liver disease
AST:ALT 2:1
31
lab tests for alcoholic liver disease
bilirubin, alk phos, GGT
PT/INR
MCV
32
alcoholic liver dz complications
cirrhotic complications
liver failure
HCC
death
33
Disulfiram/Antabuse
inhibits acetaldehyde dehydrogenase
| flushing, vomiting, nausea
34
drug induced liver injury
tylenol, statins, Atbs(amox-clauv, isoniazid), amiodarone, antifungals, valproic acid
35
pre-renal azotemia
decreased renal blood flow
decrease in glomerular hydrostatic pressure --> -->
decrease in amount of nitrogenous waste products filtered
36
Causes of pre renal azotemia
hypovolemia, hypotension
decreased CO
RAS/fibromuscular dysplasia
meds: ACEIs, NSAIDs
37
pre renal azotemia that leads to renal damage
has progressed to intrinsic renal dz
38
Intrinsic Renal Disease
damage to renal parenchyma
| depends on location: glomerular dz, tubular-interstitial dz, vascular dz
39
Type I RPGN
Good pasture syndrome
40
Type II RPGN
poststreptococcal glumerolonephritis
lupus nephritis
iga nepropathy
41
Type III RPGN
wegner granulomatosis
42
tubular-interstitial dz
ATN or AIN
43
ATN
ischemic (more common)or nephrotoxic insult
| epithelial casts, muddy-brown renal tubular casts
44
Vascular diseases
intrarenal vascular occlusion
| intrarenal vasculitis
45
intrarenal vasculitis
wegener granulomatosis
46
intrarenal vascular occlusion
renal artery/vein thrombosis
| thrombotic microangiopathies: HUS, TTP
47
Post renal azotemia
obstruction or urine outflow
48
causes of post renal azotemia
```
obstruction of urethra by BPH
neprholithiasis
neoplastic obstruction
retroperitoneal fibrosis
bilateral staghorn stones
```
49
retroperitoneal fibrosis
bilateral obstruction of ureters
50
bilateral staghorn stones
bilateral obstruction of kidneys
51
ARF symptoms
fatigue, anorexia, nausea, AMS
oliguria, hematuria, flank pain
weight gain + edema!!!
52
pre renal azotemia labs
minimal-> no proteinuria
hyaline casts
osm > 500
FeNa<1
53
intrinsic: tubular dz labs
mild-mod proteinuria
pigmented granular casts
1 FeNa
54
AIN labs
mild-mod proteinuria, leukocytes
white cells and casts, eosinophils, RBCs
1 FeNA
55
acute glomerulonephritis labs
mod to severe proteinuria
RBCs and RBC casts
>500 osm
<1 FeNa
56
postrenal azotemia labs
minimal/no proteinuria
crystals, rbcs, white cell
1 FeNa
57
imaging for ARF
ultrasound
ct
renal arteriography
renal biopsy
58
AKI complications
```
uremia
volume expanison --> pulm edema
hyperkalemia
hyponatremia
hypernatremia
metabolic acidosis
hypocalecemia
hyperphosphatemia
anemia
infections
```
59
AKI treatment
prevention
correct underlying fluid and electrolyte imbalances
dialysis
60
pre-renal AKI treatment
maintenace of euvolemia, underlying disorder treatment
| swan-ganz catheter
61
intra-renal AKI treatment
supportive
| possible immunosupp meds
62
postrenal AKi treatment
bladder catherization or surgical removemnt
63
prognosis of AKI
decreases with increasing age and severity
64
mortality in AKI
infection
| cardiorespiratory complications
65
dyspnea - broad causes
cardiac, pulmn, cirrhosis, kidney, hematological (anemia)
66
dyspnea - cardiac
ACS, CHF, pericarditis
67
dyspnea - pulm
bronchitis, pneumonia, COPD, pulmonary embolism, pulmonary fibrois, pulmonary htn
68
HAP organisms
GNR
S auerus
ventilator associated
69
Aspiration pneumonia
right lower lobes
| GN, anaerobes
70
HAP - acquire up to...
90 days after d/c (stay 2 nights)
| 30 days after nursing home/rehab
71
risk factors for aspiration
seizures
oropharyngeal muscle fatigue
cns depression
72
alcoholics - common organism for pneumonia
Klebsiella
73
pneumonia diagnosis
PA and lateral CXR
| sputum gram culture
74
methanamine silver stain
PCP
75
severe complications of pneumonia
acute respiratory failure
pleural effusion
empyema
sepsis
76
CAP treatment
azithromycin for 5 days
77
Pneumonia treatment - inpatient, non ICU
respiratory fluroquinolone (moxi/gemi/levofloxacin)
or
B lactam + macrolide
78
Pneumonia treatment - inpatient, ICU
blactum + azithromycin OR resp fluroquinolone
or
azetronam + fluroquinolone (peniclllin allergic)
79
pneumonia - pseudomonas
pipercillin-tazobactam, cefepime or imipenem
+
cipro or levofloxacin or aminoglycoside+erythromycin
80
CA MRSA pneumonia
add vanc or linezolid
81
CURB-65
predicts 30 day mortality
confusion, BUN >19, RR >30, bp: systolic <60
65 or older
82
SIRS diagnosis
```
2 or more of
HR>90
Temp 100.4
WBC 12000
RR > 20 or PaCo2<32
```
83
Sepsis diagnosis
2 or more SIRS criteria
| plus positive blood cultures or source of active infection
84
sepsis can progress to
septic shock
DIC
multiple organ dysunfction
death
85
risk factors for sepsis
```
bacteremia
advanced age
diabetes
cancer
immunosuppresion
```
86
severe sepsis
meet criteria for sepsis and evidence of organ dysfunction, hypotension, or hypoperferusion
87
Septic shock
sepsis and hypotension refractory to fluid resuscitation
88
septic shock caused by
peripehral vasodilation leading to severe drop in systemic vascular resistance
89
skin of individual in septic shock
flushed, warm
90
other lab values in patients with sepsis
elevated lactic acid
increased bun/cr
elevated liver enzymes
91
septic shock - lab values to differentiate from other types of shock
CO normal or elevated
MVO2 increased
SVR decreased
PCWP normal or decreased
92
symptoms of sepsis/septic shock
fever, hypothermia, tachycardia, tachypnea, AMS, oliguria, abd pain
93
Cause of sepsis
1) Gram Positive --> S. aureua
2) GN: E coli
3) fungal: Candida
94
if you acquire sepsis in hospital, coverage must include
MRSA, pseudomonas, e coli
95
treatment of sepsis
broad spectrum antibiotics
IV fluids
pressors
96
first line vasopressor in sepsis
norephinephrine/levophed
97
most common cause of cryptogenic organizing pneumonia
idiopathic
viral infections
drugs
CTD
98
saddle embolusm
occludes bifurcation of R and left main pulmonary arteries
99
most common cause of PE
DVTs
100
PE symtpoms
sudden onset of dyspnea, pleuritic chest pain, tachypnea, tachycardia
101
PE later findings
resp alkalosis with hypoxia and hypocarbia
loud P2
right heart failure
102
PE imaging
CT angiogram
103
V/Q scan
not used
104
gradient in PE
increased A-a gradient
areas of unused ventilation
low Pco2
105
PE CXR
normal
| may show Hamptom's hump or westermark's sign
106
hamptom's hump
wedge shaped infarct
107
westermark's sign
oligemia in affected zone
108
PE EKG classic finding
S1 s wave in 1
Q3 q wave in 3
T3 inverted t wave in III
but has to be large enough to cause cor pulmonale and new RBBB
109
PE most common EKG finding
nonspecifict St and t wave changes
110
PE treatment
thrombolytics
| 6 months of warfari (with heparin bridge)
111
PE treatment if anticoagulation can't be used
IVC filter
