OnlineMedEd: Gastroenterology - "Cirrhosis Complications" Flashcards Preview

MS3 - Adult Ambulatory Care / Rural & Community Care > OnlineMedEd: Gastroenterology - "Cirrhosis Complications" > Flashcards

Flashcards in OnlineMedEd: Gastroenterology - "Cirrhosis Complications" Deck (15)
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1
Q

The two main components of bile are _________________.

A

bilirubin and bile salts

2
Q

List the two main symptoms of hepatic encephalopathy.

A
  • AMS

* Asterixis

3
Q

Hepatic encephalopathy can be treated with what three things?

A
  • Lactulose
  • Rifaximin
  • Zinc
4
Q

Review the labs that will be abnormal in someone with cirrhosis and the complications from each.

A
  • NH3 elevated: hepatic encephalopathy
  • Estrogen elevated: gynecomastia, palmar erythema, and spider angiomata
  • Albumin decreased: peripheral edema
  • Bile salts increased: pruritus
  • Bilirubin increased: jaundice
  • Coagulation proteins decreased: increased INR
5
Q

Long-term, esophageal varices can be treated by __________________.

A

use of non-selective beta-blockers (nadolol, propranolol) to decrease portal HTN

6
Q

The major complication of TIPS is ________________.

A

hepatic encephalopathy (you bypass the liver so all the NH3 goes to the brain)

7
Q

How can you determine the type of ascites?

A

Recall that ascites can be related to portal HTN or not.

To determine if it is portal HTN, do a serum-ascites albumin gradient (SAAG). If it’s greater than 1.1, then it is portal HTN –could be cirrhosis or right-heart failure.

8
Q

In terms of physical exam maneuvers, ______________ can be helpful in diagnosing ascites.

A

testing for tympany on percussion while the patient lies flat and then on his/her sides

Gravity will pull the fluid down and tympany will not occur where the fluid has accumulated.

9
Q

How should you manage ascites?

A
  • Fluid restriction
  • Salt restriction
  • Furosemide
  • Spironolactone
  • Paracentesis
10
Q

A person with cirrhosis has any kind of change from baseline. You should immediately think ___________.

A

spontaneous bacterial peritonitis

Look for abdominal pain, fever, AMS.

Diagnosis is made with a paracentesis showing PMNs greater than 250.

11
Q

Describe prophylactic treatment of SBP.

A

Any patient with cirrhosis and a total protein less than 1.0 should be given a fluoroquinolone to prevent SBP.

12
Q

Symptomatic SBP should be treated with _______________.

A

IV ceftriaxone

13
Q

A paracentesis comes back culture negative but PMNs greater than 250. What should you do?

A

Still treat with IV ceftriaxone.

14
Q

All patients with HCC have had _____________.

A

cirrhosis or HBV

15
Q

How do you diagnose HCC?

A
  • RUQ US
  • Alpha-feto protein
  • Triple-phase CT

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