Firecracker/Step Up Cirrhosis, Dyspnea Flashcards Preview

Internal Med > Firecracker/Step Up Cirrhosis, Dyspnea > Flashcards

Flashcards in Firecracker/Step Up Cirrhosis, Dyspnea Deck (111):
1

Cirrhosis pathology

diffuse, irreversible
firbosis, necrosis, nodules

2

Cirrhosis - most common causes

Hep C > Alcohol > NAFLD > Hep B

3

Cirrhosis - less common causes

Autoimmune, PBC, PSC, Wilson's Disease, Hematochromatosis, alpha 1 antitrypsin def, drugs

4

Findings in Cirrhosis

Jaundice, Ascites, Hepatic Encephalopathy, Asterixis
Palmary erythema, spider angiomatas, gynecomastia
caput medua

5

Compensated cirrhosis

fatigue, wt loss, weakness

6

Decompensated cirrhosis

ascites, edema
confusion, pruritis
hematemesis, melena

7

liver biopsy for cirrhosis

presence of fibrosis
regenerating hepatic nodules
decreased number of septa

8

ultrasound in cirrhosis

assess countour of liver
impedeance of blood flow
amount of ascites

9

Severe Complications of cirrhosis

SBP, varices
hepatorenal/hepatopulmonary syndrome
portal vein thrombosis, cardiomyopathy, hepatic encephalopathy

10

Treatments for Cirrhosis

beta blockers
lactulose
TIPS

11

hepatic congestion can occur secondary to

right sided heart failure
constrictive pericarditis

12

treatment of varices

IV antibiotics
IV octreotide for 3-5 d
beta blockers
endoscopic treatment

13

albumin in cirrhosis

hypoalbuminemia = reduced oncotic pressure

14

SAAG > 1.1

portal HTN likely

15

fetor hepaticus

musty odor of breath
associated with hepatic encephalopathy

16

SBP most common causes

e coli
klebsiella
s. pneumonia

17

how to treat coagulopathy in cirrhosis

FFP (not vit k)

18

ascites usually found in

portal htn/increased hydrostatic pressure
hypoalbuminemia
malignacies - ovarian
infections - tb

19

clinical presentation of ascites

abdominal swelling and wt gain
SOB

20

physical exam for ascites

bulging flanks
fluid waves
shifting dullness

21

evaluation of ascitic fluid

apperance
albumin, total protein
cell count, cell culture

22

causes of portal htn with SAAG > 1.1

Budd-Chiari
CHF
constrictive pericarditis

23

SAAG < 1.1

nephrotic syndrome
cancer

24

complications of ascites

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