Alcoholic Liver

Front 1

AST/ALT
a.) <1
b.) > 2

Back 1

a.) viral hepatitis, chronic active hepatitis, cholestatic jaundice
b.) alcoholic liver disease/ alcoholic hepatitis, cirrhosis

Front 2

ALP (or ALK) normal range

Back 2

130-130

Front 3

GGT normal range
a.) males
b.) females

Back 3

a.) 9-69
b.) 3-33

Front 4

albumin normal range

Back 4

4-6

Front 5

value indicating thrombocytopenia

Back 5

<150,000

Front 6

What 2 things should you look out for when modifying the MELD score?

Back 6

1.) SCr < 1 is always 1
2.) If pt gets dialyzed twice in one week, SCr = 0.4

Front 7

When to dose adjust via child-pugh

Back 7

Grade B or C

Front 8

Treatment for cirrhosis
a.) when to treat
b.) drug
c.) 2nd line (above C/I)

Back 8

a.) severe cirrhosis: MELD>18 or hepatic encephalopathy
b.) prednisone 40mg/day for 28 days; followed by 2 weeks
c.) pentoxifylline 400mg PO for 4 weeks

Front 9

Portal hypertension
a.) mm Hg
b.) prophylaxis
c.) goal HR

Back 9

a.) > 10mmHg
b.) non-selective bblocker: propranolol 20mg BID or nadolol 20-40mg daily
c.) titrate q3-5 days until HR 55-60bpm

Front 10

Ascites: pharm therapy
a.) drugs (2) + dose

Back 10

1.) baclofen 5mg TID x 3 days; 10mg TID
2.) diuretics: spironolactone 100mg daily and furosemide 40mg daily; max dose 400:160mg

Front 11

Ascites: diuretics
a.) target weight loss
b.) when to dc (labs, 2)
c.) when to dc (status, 2)

Back 11

Spironolactone 100mg daily & furosemide 40mg daily
a.) 0.5kg
b.) SCr>2; Na <120 (hyponatremia)
c.) active GI bleeding; uncontrolled or recurrent hepatic encephalopathy

Front 12

SAAG
a.) when to use & where to get
b.) equation
c.) what the numbers mean

Back 12

a.) use to figure out ascites etiology. get from differential diagnosis (50mL)
b.) SAAG = serum albumin - ascites albumin
c.) >1.1 g/dL = portal hypertension;
<1.1 g/dL = not portal HTN. peritoneal cancer/infection or nephrotic syndrome

Front 13

Ascites: TAP
a.) when to use
b.) when to supplement with albumin

Back 13

a.) tense ascites. need to get out 5-20L
b.) fluid draw > 5L. give 6-8 g albumin for every L

Front 14

Ascites: lifestyle modification (2)

Back 14

1.) <2,000mg sodium/day
2.) abstain from alcohol

Front 15

Spontaneous bacterial peritonitis
a.) marker!

Back 15

a.) absolute PMN count > 250 cells. if PMN <250 but there are signs and symptoms of infection, then initiate empiric therapy anyways

Front 16

Spontaneous bacterial peritonitis
a.) first line treatment (2)
b.) alternative treatment

Back 16

a.) 3rd gen cephs: ceftriaxone or cefotaxime
b.) ciprofloxacin or ofloxacin

Front 17

SBP: prophylaxis
a.) long term - who & drugs
b.) short term - who & drugs

Back 17

a.) those who had SBP before. Bactrim or norfloxacin daily
b.) those with cirrhosis + GI bleed. Ceftriaxone or norfloxacin for 7 days

Front 18

Hepatic encephalopathy
a.) etiology
b.) symptoms (2)

Back 18

a.) ammonia build-up (30-70 mcg)
b.) asterixis, fetor hepaticus (sweet breath/urine)