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18 Cards in this Set
- Front
- Back
AST/ALT
a.) <1 b.) > 2 |
a.) viral hepatitis, chronic active hepatitis, cholestatic jaundice
b.) alcoholic liver disease/ alcoholic hepatitis, cirrhosis |
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ALP (or ALK) normal range
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130-130
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GGT normal range
a.) males b.) females |
a.) 9-69
b.) 3-33 |
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albumin normal range
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4-6
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value indicating thrombocytopenia
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<150,000
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What 2 things should you look out for when modifying the MELD score?
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1.) SCr < 1 is always 1
2.) If pt gets dialyzed twice in one week, SCr = 0.4 |
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When to dose adjust via child-pugh
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Grade B or C
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Treatment for cirrhosis
a.) when to treat b.) drug c.) 2nd line (above C/I) |
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 |
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Portal hypertension
a.) mm Hg b.) prophylaxis c.) goal HR |
a.) > 10mmHg
b.) non-selective bblocker: propranolol 20mg BID or nadolol 20-40mg daily c.) titrate q3-5 days until HR 55-60bpm |
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Ascites: pharm therapy
a.) drugs (2) + dose |
1.) baclofen 5mg TID x 3 days; 10mg TID
2.) diuretics: spironolactone 100mg daily and furosemide 40mg daily; max dose 400:160mg |
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Ascites: diuretics
a.) target weight loss b.) when to dc (labs, 2) c.) when to dc (status, 2) |
Spironolactone 100mg daily & furosemide 40mg daily
a.) 0.5kg b.) SCr>2; Na <120 (hyponatremia) c.) active GI bleeding; uncontrolled or recurrent hepatic encephalopathy |
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SAAG
a.) when to use & where to get b.) equation c.) what the numbers mean |
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 |
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Ascites: TAP
a.) when to use b.) when to supplement with albumin |
a.) tense ascites. need to get out 5-20L
b.) fluid draw > 5L. give 6-8 g albumin for every L |
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Ascites: lifestyle modification (2)
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1.) <2,000mg sodium/day
2.) abstain from alcohol |
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Spontaneous bacterial peritonitis
a.) marker! |
a.) absolute PMN count > 250 cells. if PMN <250 but there are signs and symptoms of infection, then initiate empiric therapy anyways
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Spontaneous bacterial peritonitis
a.) first line treatment (2) b.) alternative treatment |
a.) 3rd gen cephs: ceftriaxone or cefotaxime
b.) ciprofloxacin or ofloxacin |
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SBP: prophylaxis
a.) long term - who & drugs b.) short term - who & drugs |
a.) those who had SBP before. Bactrim or norfloxacin daily
b.) those with cirrhosis + GI bleed. Ceftriaxone or norfloxacin for 7 days |
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Hepatic encephalopathy
a.) etiology b.) symptoms (2) |
a.) ammonia build-up (30-70 mcg)
b.) asterixis, fetor hepaticus (sweet breath/urine) |