GI 5 treatments Flashcards
(18 cards)
How do you manage MAFLD?
1) Abstinence from alcohol
2) Vaccination for hepatitis A & B, pneumococcal, influenza, DTP
3) Weight loss
4) Manage diabetes & insulin resistance-diet, exercise, meds
5) Manage dyslipidemia
MAFLD vs alcoholic liver disease: What does the management of both have in common?
1) Abstinence from alcohol
2) Manage DM, insulin resistance and dyslipidemia
3) Need Immunizations
What are some management differences between MAFLD and alcoholic fatty liver disease?
1) MAFLD patients do not typically become unstable or need admitted to the hospital
2) Alcoholic: replace micronutrients, avoid nephrotoxic drugs
-Methylprednisolone x 1 month in alcoholic hepatitis may reduce short-term mortality
List the management for MAFLD and AFLD (alcoholic fatty liver disease)
1) MAFLD: No pharmacologic agents. Improve risk factors.
2) AFLD: Steroids only with severe disease
Describe management of Hep B
1) Mainly supportive
2) Measures to prevent infection in exposed contacts
3) Admission: coagulopathy, significant jaundice, encephalopathy
4) Consider admission: older pts, significant comorbidities, unable to tolerate PO fluids, poor social support system
5) Treatment with antiviral therapy unsettled (<1% risk of fulminant hepatitis, <5% of chronic hepatitis B in adult acquired infections)
Chronic Hep B: List at least 3 medications
(Just know oral for 12wks)
1) Entecavir (baraclude): daily PO 2 hrs before or after meal
2) Tenofovir: daily PO (dosage depends on brand)
3) Interferon (preferred is peginterferon alpha-2a weekly SC injection, but can not use in cirrhosis)
4) Things to consider for treatment: renal function, ALT (elevated x 3-6 mo) and DNA viral levels ( >20,000 IU/mL (105 copies/mL) and amount of liver fibrosis/cirrhosis
What should you do once an active Hep B infection is confirmed?
1) Send pt for quantitative HBV DNA, HBeAg, HIV, HAV Ab, HCV Ab, CBC, CMP, PT/INR, U/S liver
2) Provide pt education on precautions to prevent transmission
3) Refer to infectious disease specialist or gastroenterology
4) Caution to avoid EtoH
5) Vaccinate for HAV
Describe Hep C Tx
1) Confirm active infection: ensure no spontaneous clearance (detectable HCV level over 6-month period)
2) Rule out concomitant HIV & HBV infections
3) Determine genotype (possible resistance to treatment)
4) Classify as treatment-naïve or treatment-experienced
5) Assess for cirrhosis via fibro-scan or blood test (affects management)
6) Treat with appropriate agent (pan-genotypic agent preferred)
7) Repeat HCV RNA at 12-weeks post-treatment to assess for sustained virologic response (SVR)/cure
Main determinants for agent & duration of Hep C are what?
Treatment status (naïve vs experienced) & absence/presence of cirrhosis, genotype
List the major goals of cirrhosis management
1) Slowing or reversing progression of liver disease (ie, cure hep C, alcohol abstinence)
2) Preventing superimposed insults to liver (get vaccinations, avoid hepatotoxins (meds, alcohol)
3) Identify medications for dose adjustments or avoidance
4) Managing symptoms & lab abnormalities (ie, muscle cramps, umbilical hernia, hyponatremia)
5) Preventing, identifying, & treating complications
6) Determining appropriateness & optimal timing for transplantation: complications (MELD score, CP score) refer to GI or hepatology
-Child-Pugh score (A-C) – HE, ascites, t bili, albumin, PT/INR
Cirrhosis complications:
1) What is a major way to deal with ascites?
2) What do you have a high index of suspicion/low threshold early antibiotics for?
1) TIPS
2) SBP (Spontaneous Bacterial Peritonitis)
Cirrhosis complications:
1) What are 2 a major ways to deal with ascites?
2) What do you have a high index of suspicion/low threshold early antibiotics for?
1) TIPS; < 2G sodium/day
2) SBP (Spontaneous Bacterial Peritonitis)
Cirrhosis complications: What should you do for HCC? How do you screen for this?
1) Refer to hepatology/liver transplant specialist
2) Q6mo abd u/s +AFP
How do you manage Acute (secondary) peritonitis?
1) NPO, IVF, broad spectrum antibiotics
2) Generalized: rapid resuscitation & surgical exploration
What are some treatments for Spontaneous Bacterial Peritonitis (SBP) (complication of ascites)
Antibiotics, paracentesis, liver transplant referral
Ascites complications; Hepatorenal syndrome management:
What is the ideal therapy?
Ideal therapy is improvement in liver function via…
1) Recovery from alcoholic hepatitis
2) Treatment of decompensated hepatitis B (antiviral therapy)
3) Recovery from acute hepatic failure
4) Liver transplantation
Hepatorenal syndrome management: When improved liver function not possible (short term,) then what do you do?
1) Medical therapy to reverse AKI
-ICU admission?
-Liver transplant candidate?
2) Failure of medical therapy: dialysis vs TIPS
Fulminant (sudden onset) Hepatic Failure: How do you manage this?
1) Monitor for cerebral edema and renal failure
2) Need good PO nutrition with protein
3) Often leads to liver transplant
