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Liver disease Flashcards

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1
Q

symptoms of liver disease

A

N/V/D; loss of appetite; malaise; dark urine; yellow skin/eyes; pale colored stools; right upper quadrant pain; fatigue

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2
Q

when looking at the labs of a patient with liver disease you would suspect all of them to be increasing except

A

albumin (albumin decreases in liver failure)

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3
Q

child pugh and model for end stage liver disease (MELD) measure what

A

severity of liver disease

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4
Q

what natural product can be given for liver health

A

milk thistle

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5
Q

what is the most common type of drug induced liver disease

A

alcoholic liver disease

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6
Q

what nutrition must be provided to patients suffering from Alcoholic liver disease

A

thiamine (b1) and folic acid

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7
Q

what are the complications of liver disease

A

hepatic encephalopathy; portal hypertension; variceal bleeding; ascites

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8
Q

portal hypertension can cause what complications

A

variceal bleeding; ascites; hepatic encephalopathy

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9
Q

what can be given to treat/prevent portal hypertension

A

propranolol or nadolol (non selective beta blockers) variceal ligation

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10
Q

what is the goal HR when treating portal hypertension

A

55 to 66BPM

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11
Q

contraindications to using non selective beta blockers

A

2nd or 3rd degree block; respiratory issues; sick sinus syndrome

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12
Q

what are the side effects of non selective beta blockers

A

lightheadedness; shortness of breath; dizziness

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13
Q

after making sure the patient is hemodynamically stabilized what agents can be given for variceal bleeding

A

octreotide or vasopressin

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14
Q

why is octreotide preferred over vasopressin

A

selective for splanchnic vessels vasopressin is non selective

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15
Q

what surgical interventions can be done for variceal bleeding

A

shunts; balloon tamponade

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16
Q

how long is octreotide given

A

5 days

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17
Q

how long is vasopressin given

A

24 hours max

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18
Q

pitressin

A

vasopressin

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19
Q

what is usually given along with vasopressin

A

IV nitroglycerin

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20
Q

vasopressin is an analog of what hormone

A

ADH

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21
Q

symptoms of hepatic encephalopathy

A

musty odor (breath/urine) loss of small hand movement (hand writing) altered mental status

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22
Q

the symptoms of hepatic encephalopathy are due to accumulation of ____ in the blood

A

ammonia; glutamate

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23
Q

what are the dietary restrictions for hepatic encephalopathy

A

protein intake 1 to 1.5 g/kg (fish and dairy preferred source due to lower calorie:nitrogen) BCAA (leucine isoleucine valine) favored.

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24
Q

what drugs are given for hepatic encephalopathy

A

lactulose (1st line) rifaximin (2nd line) metronidazole neomycin zinc

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25
how does lactulose work
prevents bacteria production of ammonia and leeches ammonia into colon for excretion
26
how do the antibiotics used in hepatic encephalopathy work
decrease bacterial ammonia production (inhibit urease producing bacteria)
27
what probiotics can be used in hepatic encephalopathy
lactobacilli; lactococci; bifidobacteria
28
what dose of Zinc can be given for hepatic encephalopathy
220 mg BID
29
lactulose treatment and prevention dose is titrated to?
treatment 2 to 3 bowel movements
30
prevention 2
4 bowel movements
31
lactulose side effects
flatulence; abdominal pain; diarrhea
32
neomycin is not used long term due to
ototoxicity; nephrotoxic; breathing problems;
33
metronidazole is not used long term due to
peripheral neuropathy
34
rifaximin side effects
peripheral edema; ascites; flatulence
35
spontaneous bacterial peritonitis and hepatorenal syndrome can result from
ascites
36
a patient with ascites will present with
abdominal distention
37
how do you manage ascites
< 2 g sodium per day
38
furosemide and spironolactone 40 mg to 100 mg (always in that ratio)
furosemide and spironolactone 40 mg to 100 mg (always in that ratio)
39
fluid restriction if serum Na is < 120 mEq
fluid restriction if serum Na is < 120 mEq
40
when treating ascites with diuretic therapy how much fluid do you try to remove per day
0.5 kg/day MAX
41
what agents should you avoid in ascites
NSAIDs; Ibuprofen ( sodium retention)
42
luid restriction in ascites only for what patients
symptomatic severe hyponatremia serum na < 120 mEq
43
which form of hepatitis is: self limiting; does not lead to chronic infection
Hep A
44
which form of hepatitis is: transferred via fecal oral route (contaminated food)
Hep A
45
Havrix; Vaqta are vaccines for
Hep A
46
what are risk factors of Hep A
homosexual; prositutes; infected animals; IV drug useres
47
what is the vaccine schedule for hep B
0; 1; 6 months when using Engerix B
48
Engerix B is the vaccine for
Hep B
49
Recombivax HB is the vaccine for
Hep B
50
which form of hepatitis is: silent until chronic disease emerges
hep C
51
how is Hep C primarily transmitted in the US
iv drug use
52
what are the genotypes of Hep C and how long do you treat
type 1 (48 weeks) type 2&3 (24 weeks)
53
pegylated interferon has what added to it
polyethylene glycol (enhances half life)
54
interferon black box warning
may worsen autoimmune; infectious; ischemic; or neuropsychiatric disorders
55
what side effect will all patients experience when taking interferons and (how do you treat it and how long does it last)
flu like symptoms (pretreat with APAP or antihistamine can last up to 24 hours)
56
interferon should be withheld when
ANC < 500 or platelets < 25;000
57
where are interferons injected
SQ into abdomen thigh or upper arms
58
ribavirin treats
hep c only
59
when should you check for early viral response when a patient is on ribavirin
by week 12 (stop if no early viral response)
60
ribavirin is not recommended at a CrCl of
< 50
61
what is the black box warning for ribavirin
teratogenic; hemolytic anemia
62
Contraindications to ribavirin
Pregnancy; CrCl<8.5g/dl
63
ribavirin side effects
hemolytic anemia; worsen cardiac issues; insomnia; anorexia; increased uric acid
64
ribavirin is pregnancy category
X
65
how long should patients be using 2 forms of contraception when on ribavirin
throughout treatment and 6 months following
66
do not use ribavirin with
didanosine (risk of fatal hepatic failure; peripheral neuropathy; pancreatitis)
67
ribavirin may increase levels of
NRTI
68
what protease inhibitors treat Hep C
bocepavir (Victrelis); Telaprevir (Incivek); Simeprevir (Olysio)
69
What dose riba mean
R-renal CrCl<50 = CI; I- Interferon must be used; B-birth defects; 2 forms of BC must be used during & 6 months after; A- Anemia; hemolytic

Infectious Disease (7 decks)

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