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GI Exam 2 > Hepatic Encephalopathy > Flashcards

Hepatic Encephalopathy Flashcards

1
Q

What are 3 symptoms of overt HE?

A
  1. Altered mental status
  2. Fatigue
  3. Coma
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2
Q

What are 2 symptoms of sub clinical or minimal HE?

A
  1. Mild cognitive impairment
  2. Coordination declining
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3
Q

What is the best marker for HE?

A

Ammonium

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4
Q

Grade for encephalopathy: shortened attention span with mild asterixis or tremor and mild lack of awareness

A

1

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5
Q

Grade for encephalopathy: Lethargic, is disoriented with inappropriate behavior. Obvious aterixis and slurred speech

A

2

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6
Q

Grade for encephalopathy: somnolent but arousable, gross disorientation with bizarre behavior. Has muscular rigidity and clonus; hyperflexia

A

3

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7
Q

Grade for encephalopathy: Coma with decerebrate posturing

A

4

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8
Q

What are 4 precipitating factors of HE?

A
  1. Therapy non-compliance
  2. TIPS
  3. Medications (benzodiazepines, narcotics)
  4. Upper GI bleed
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9
Q

True or false: you should restrict protein in HE

A

False

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10
Q

What MOA do you want the medications to have to treat HE?

A

Decrease nitrogen load in the GI tract

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11
Q

What are 2 treatments for HE?

A
  1. Lactulose
  2. Rifaximin
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12
Q

What is the MOA of lactulose?

A

Cathartic; reduces nitrogen absorption in the GI due to increased transit

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13
Q

What is lactulose metabolized to?

A

Acetic acid and lactic acid

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14
Q

What is the dosing for lactulose?

A

30-45 mL (20-30 g) Q4-6

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15
Q

How many bowel movements do you want for a titration of lactulose?

A

2-3 loose stool bowel movements daily

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16
Q

For a retention enema what is the dose for lactulose?

A

300 mL lactulose + 700 mL saline

17
Q

What are 2 nonobvious symptoms of lactulose?

A
  1. Hyponatremia
  2. Hypokalemia
18
Q

What does rifaximin decrease?

A

Urease producing bacteria in the GI tract

19
Q

What is the dose for rifaximin?

A

550 mg BID

20
Q

What are 5 ADRs of Rifaximin?

A
  1. Abdominal pain
  2. Nausea
  3. Flatulence
  4. Dizziness
  5. Headache
21
Q

What drug has better compliance?

A

Rifaximin

22
Q

What is selection for Rifaximin and lactulose depend on?

A

Insurance

23
Q

What are 6 causes of liver disease?

A
  1. Alcoholic hepatitis
  2. Fatty liver/MASH
  3. Drug induced liver disease
  4. Hepatitis
  5. Hemochromatosis
  6. Wilson’s disease
24
Q

What 3 major lesions can occur in alcoholic liver disease?

A
  1. Fatty liver
  2. Cirrhosis
  3. Alcoholic lesions
25
Q

Alcoholic hepatitis is _____ hepatic inflammation

A

Acute

26
Q

What are 3 mechanisms of injury for alcoholic hepatitis?

A
  1. Ethanol metabolism
  2. Inflammation
  3. Innate immunity
27
Q

What is the cardinal symptom of alcoholic hepatitis?

A

Acute jaundice

28
Q

What are 4 clinical presentations of alcoholic hepatitis?

A
  1. Acute jaundice
  2. Fever
  3. New onset ascites
  4. Hepatomegaly
29
Q

What does the modified discriminate function (mDF) score need to be in order to treat?

A

32

30
Q

What criteria allows for corticosteroids to be used?

A
  1. mDF >32
  2. Hepatic encephalopathy
31
Q

What corticosteroid is utilized for HE?

A

Prednisone (40 mg)

32
Q

What 4 things are contraindicated for the use of steroids?

A
  1. Infection
  2. GI bleed
  3. Acute pancreatitis
  4. Renal failure
33
Q

Pentoxifylline

A

TRENTAL

34
Q

What is the MOA of TRENTAL?

A

Phosphodiesterase inhibitor and decreased transcription of the TNF-a promoter

35
Q

True or false: pentoxifylline is used as second line therapy to steroids

A

True

36
Q

When are patients able to get a liver transplant?

A

If they have 6 months of documented alcohol abstinence

GI Exam 2 (11 decks)

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