Liver Stuff

Question 1

Drugs to avoid in cirrhosis pt

Answer 1

Opioids, sedatives and barbiturates

Question 2

Complication of esophageal balloon tamponade

Answer 2

Esophageal necrosis, perforation, aspiration, asphyxiation, and stricture

Question 3

Beta-blockers given in pt with cirrhosis to

Answer 3

reduce resting pulse, reducing portal htn and strain on the vessels

Question 4

Serum bilirubin

Answer 4

Measures ability of liver to conjugate and excrete bilirubin

Question 5

Albumin level

Answer 5

3.5 - 5.5 g/dl

Question 6

Serum ammonia level

Answer 6

Measures ability of liver to convert ammonia to urea

15-45 mcg/dl

Question 7

Norm PT; INR; vit k

Answer 7

PT: 12-16 sec
INR: 1.0
Vit K: 0.1-2.2 ng/ml

Question 8

Norm ALP/AST/ALT

Answer 8

ALP: 50-200 U/L
AST: 10-40 males; 15-30 females
ALT: 10-40 male; 8-35 female

Question 9

Norm cholesterol and platelet ct

Answer 9

Serum cholesterol: 150-200

Platelet ct: 150,000-450,000

Question 10

Diagnostic tests for liver dz

Answer 10

Liver ultrasound, CT scan, MRI, liver biopsy

Question 11

S/S of Hepatocellular Jaundice

Answer 11

• Mild or severely ill
• Lack of appetite, N/V, wt loss
• malaise, fatigue, weakness
• headache, chills, fever, infection

Question 12

S/S of Obstructive Jaundice

Answer 12

• Dark urine, clay-colored stool
• dyspepsia & intolerance of days, impaired digestion
• pruritus

Question 13

Edema r/t

Answer 13

• decreased hepatic synthesis of albumin

- inability to metabolize aldosterone– inc fl retention

Question 14

Macrocytic anemia

Answer 14

folic acid deficiency

Question 15

Portal htn can lead to…

Answer 15

• esophageal varices
• hypersplenism
• intestinal varices
• varices around umbilicus
• ascites

Question 16

Tx of ascites

Answer 16

• low Na+ diet
• diuretics– sprinolactone
• bed rest- inc GFR
• paracentesis
• SPA
• TIPS

Question 17

First line tx for ascites

Answer 17

-paracentesis & SPA

Question 18

Wernicke-korsakoff syndrome from…

Answer 18

Thiamine deficiency

Question 19

Hepatic encephalopathy: stage 1

Answer 19

Norm LOC; lethargy & euphoria; asterixis; impaired writing & inability to draw lines

Question 20

Hepatic encephalopathy: stage 2

Answer 20

Increased drowsiness; disorientation; inapprop behavior; mood swings; agitation; fetor hepaticus; abnorm EEG

Question 21

Hepatic encephalopathy: stage 3

Answer 21

Stupor; diff to arouse; marked confusion; increased DTRs; tremors; rigidity

Question 22

Hepatic encephalopathy: stage 4

Answer 22

Comatose; absence of DTRs & asterixis; ICU

Question 23

Meds for hepatic encephalopathy

Answer 23

• Lactulose– promote intestinal excretion of NH3
• neomycin– kills nitrogen-forming bacteria in GI tract
• IV glucose to minimize protein breakdown

Question 24

Paracentesis used for…

Answer 24

• removal of fluid

- cell ct, protein & albumin levels

Question 25

Salt-Poor Albumin (SPA)

Answer 25

Causes ascitic fluid to be drawn back into circulation & excreted by kidneys; given iv

Question 26

Spider angiomas caused by...

Answer 26

Decreased aldosterone

Question 27

What should you administer when giving vasoconstrictors?

Answer 27

NTG

Question 28

Sengstaken-blakemore: how many lumens?

Answer 28

3!! - lavage/gastric aspiration; 2 to inflate gastric & esophageal balloons

Question 29

Preferred med for bleeding varices...

Answer 29

Sandostatin (octreotide acetate) | Propranolol(indural) to decrease portal pressure

Question 30

Hepatorenal syndrome

Answer 30

Acute renal failure accompanied by azotemia, oliguria, and ascites-- renal vasoconstriction

Question 31

Transjugular intrahepatic portosystemix Shunt (TIPS) for portal htn

Answer 31

Reduces portal pressure by expandable stent between the hepatic and portal veins-- shunts to bloodstream

Question 32

Which hepatitis can resolve?

Answer 32

Hepatitis A

Question 33

Management for Hep B

Answer 33

Interferon and antiviral agent

Question 34

Give HBig

Answer 34

Within 24 hrs of exposure-- passive immunity for 4 weeks

Question 35

Hep C exposure

Answer 35

Post Exposure Prophylaxis-- anti-hvc testing for person who is source and baseline Anti-hcv and ALT testing on exposed person for 4-6 wks - interferon monotherapy given if elevated levels Don't get pregnant for at least 6 mo after interferon tx

Question 36

Side effects for interferon therapy

Answer 36

Flu-like symptoms, bone marrow suppression, suicidal ideation, ischemic disorders, teratogenic

Question 37

4 types of hepatic cirrhosis

Answer 37

- alcoholic- most common - postnecrotic- hepatitis - biliary-blockage of bike ducts - cardiac- long standing right-sided HF

Question 38

S/S of liver cancer

Answer 38

Vague; continuous dull ache RUQ, epigastric or back pain, anorexia, wt loss, weakness, jaundice and ascites

Question 39

What to give for DTRs

Answer 39

Ativan