Liver

Question 1

how do you treat cirrhosis?

Answer 1

Ascites + edema: sodium restriction, diuretics
Pruritus: cholestyramine

US every 6 months

Question 2

how do you treat acute hep A

Answer 2

Bed rest
N/V → IV glucose
Avoid strenuous exertion, alcohol, hepatotoxic agents

Question 3

How do you treat hep B?

Answer 3

Bed rest
N/V → IV glucose
Avoid strenuous exertion, alcohol, hepatotoxic agents

Hospitalize if:
Encephalopathy or severe coagulopathy = acute liver failure
Liver transplant

Question 4

How do you treat HCV?

Answer 4

Eradicate infection and prevent disease progression (defined as absence of HCV RNA in serum 12 weeks following completion of antiviral therapy

Sofosbuvir + velpatasvir x 12 weeks
OR glecaprevir + pibrentasvir x 8 weeks

Question 5

How do you treat HDV?

Answer 5

Pegylated interferon alfa 2b

Question 6

How do you treat hep E?

Answer 6

3 month course of oral ribavirin (severe)

Question 7

How do you treat hep B?

Answer 7

Nucleoside or nucleotide analogs → lower HBV DNA and normalize ALT and histologic improvement
Entecavir or tenofovir

Question 8

How do you treat hep chronic hep C

Answer 8

20% progress to cirrhosis
Antivirals: glecaprevir and pibrentasvir
Sofosbuvir and velpatasvir

Question 9

autoimmune hepatitis tx

Answer 9

Prednisone +/- azathioprine

Question 10

How do you treat alcohol-associated liver disease?

Answer 10

Abstinence from alcohol (acamprosate, naltrexone, baclofen, topiramate, gabapentin)

Nutritional support, supplement nutritional deficiencies
Steroids

Admit when:
-Hepatic encephalopathy is present
-INR >1.6
-Total bilirubin 10+
-Inability to maintain hydration

Question 11

How do you treat CN syndrome?

Answer 11

Type I: phototherapy, criss = plasmapheresis, liver transplant
Type II: phenobarbital if needed

Question 12

Do GS or DJS need treatment?

Answer 12

no

Question 13

How do you treat ascites?

Answer 13

Na+ restriction <2g/day, diuretics
Spironolactone + lasix

Refractory = large volume paracentesis
>5L removed = add albumin replacement

Question 14

how do you treat hepatic encephalopathy

Answer 14

Decrease intestinal ammonia production/increase excretion
– lactulose - neutralizing ammonia
– rifaximin

eat!

Question 15

what’s the treatment for fatty liver disease?

Answer 15

Vitamin E
Thiazolidinediones reverse insulin resistance (leads to weight gain)
Metformin
Pentoxifylline
semaglutide/liraglutide
ACEI
Surgery if BMI > 35, liver transplant
Weight loss, dietary restriction, increased fiber, moderate exercise, Mediterranean diet, fasting

Question 16

How do you treat hepatic vein obstruction (Budd-Chiari syndrome)?

Answer 16

Manage hypercoagulable conditions, ascites
Antigulation x 3 months
-> lifelong in Budd Chiari syndrome

Angioplasty, stenting, TIPS

Question 17

How do you treat hepatocellular carcinoma?

Answer 17

Eradicate viral infection, chemo, surgical resection, local treatments, transplant

Question 18

how do you treat liver failure?

Answer 18

Achieve metabolic and hemodynamic stability
Intravascular volume preservation (but avoid large-volume infusions)
Norepinephrine vasopressor, + vasopressin if persistent
Prevent hypoglycemia
Intermittent renal replacement therapy
Preserve muscle mass = enteral administration of protein (monitor ammonia)
H2 receptor or PPI prophylaxis
Broad spectrum antibiotic prophylaxis
Acetylcysteine for acetaminophen toxicity
Liver transplantation