Term
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Definition
decreased fatty acids metabolism--> fat accumulates; decreased hepatocyte oxygen utilization; increased susceptibility to additional injury |
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Term
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Definition
replacement by fibrous tissues = cirrhosis |
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Term
pathophysiology of cirrhosis |
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Definition
late stage of progressive hepatic fibrosis; injured hepatocytes; hepatocyte death; irreversible in advance stages ---> only option is liver transplant |
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Term
liver unable to function enough to prevent systemic symptoms |
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Definition
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Term
decreased flow of blood and bile through liver; restricted bile removal = increased bilirubin in blood |
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Definition
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Term
vascular constriction in the liver; portal hypertension = varice formation |
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Definition
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Term
decreased albumen produced by liver; vascular system unable to maintain osmotic gradient; increased sodium/fluid retention; fluid pools in abdominal cavity |
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Definition
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Term
decreased number of functional hepatocytes; decreased blood flow through portal vein -- reduced removal of waste from gut flora; toxins/by products build up in systemic circulation |
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Definition
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Term
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Definition
markers of hepatocyte damage |
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Term
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Definition
aminotransferases (ALT; AST) |
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Term
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Definition
Alkaline Phosphatase and y-Glutamyl Transpeptidase, bilirubin |
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Term
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Definition
low platelets, or sequestering of platelets |
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Term
Mayo End-Stage Liver Disease (MELD) |
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Definition
used for allocation priorities of patients with liver failure; United Network for Organ Sharing; 3 month mortality estimation |
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Term
Primary PROPHYLAXIS of Portal Hypertension and Variceal bleeding |
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Definition
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Term
DO NOT use these with hemorrhage |
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Definition
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Term
acute blood loss + decreased blood pressure |
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Definition
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Term
Acute variceal hemmorrage treatment |
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Definition
Octreotide bolus + continuous infusion |
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Term
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Definition
somatostatin analog-- splanchnic vasoconstrictor |
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Term
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Definition
for acute variceal hemorrhage--- associated with higher adverse events (use Octreotide if possible!) |
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Term
Used in acute variceal hemorrhage for 5-7 days |
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Definition
Fluoroquinolones (cipro, levo) OR 3rd gen cephalosporin (preferred if high prevalence of E. Coli Fluroquinolone resistance) |
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Term
Secondary prophylaxis of variceal hemorrhage |
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Definition
non selective beta blocker + endoscopic band ligation |
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Term
if unable to do EBL in prevention of recurrent variceal hemorrhage then use ____ (improved median rebleeding rate vs NSBB alone; increased side effect rate) |
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Definition
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Term
abdominal pooling of fluid; full "bulging" abdomen; flank dullness, shifting dullness |
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Definition
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Term
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Definition
severe portal hypertension + hepatic insufficiency |
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Term
splanchnic arterial vasodilation + decreased peripheral resistance |
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Definition
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Term
excess renin-angiotensin-aldosterone system activation |
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Definition
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Term
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Definition
sodium restriction; fluid restriction; Spironolactone + Furosemide |
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Term
rapid relief of ascites --> does not correct underlying problem |
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Definition
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Term
Spontaneous bacterial peritonitis (SBP) |
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Definition
infection of ascetic fluid-- translocatin of GI bbacteria |
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Term
Diagnostic Paracentesis (SBP) |
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Definition
Polymorphonuclear Leukocyte >/= 250 cells/mm3 |
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Term
signs and symptoms of SBP |
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Definition
fever, leukocytosis; Abd pain, rebound tenderness, decreased bowel sounds |
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Term
Spontaneous bacterial peritonitis txt |
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Definition
3rd gen cephs (Ceftriaxone, Cefotaxime) preferred if prior recent FQ exposure; Fluroquinolones (levofloxacin, Moxifloxacin, Ciprofloxacin); Piperaccilin-tazobactam; Possible ESBL--- use Carbapenem |
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Term
SBP txt with possible ESBL (Superbug infection--- usually E. Coli + Klebsiella--- resistance to penicillins) |
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Definition
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Term
After 1st episode of SBP, variceal hemorrhage, low protein ascites: |
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Definition
Fluoroquinalone or TMP/SMX DS PO daily |
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Term
mental status changes associated with increased ammonia (accumulation in the CNS); cirrhotic liver; produced by GI flora: urease-producing bacteria |
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Definition
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Term
treatment of choice for hepatic encephalopathy |
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Definition
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Term
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Definition
decreases ammonia production and increased ammonia elimination |
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Term
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Definition
alternative/additive therapy to Lactulose; targets gut flora (non-absorbable abx)--- higher dose for traveler's diarrhea |
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Term
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Definition
usually used in combination with lactulose-- ototoxicity and nephrotoxicity |
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Term
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Definition
long term use --> neurotoxicity (alternative in hepatic encephalopathy) |
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Term
prevention of recurrent hepatic encephalopathy |
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Definition
protein diet restriction; lactulose, rifamixin; zinc supplementation |
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Term
severe alcoholic hepatitis +/- encephalopathy |
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Definition
prednisolone; pentoxifylline |
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Term
Active metabolite of prednisone; 5 studies show decreased short term mortality compared to placebo; 8 studies showed no effect |
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Definition
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Term
oral phosphodiesterase inhibitor; 40% in house mortality lower than placebo; no improvement in 2 month survival |
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Definition
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Term
Type 1 hepatorenal syndrome (HRS) |
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Definition
rapidly progressive; 95% mortality < 1 month if untreated |
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Term
Type 2 hepatorenal syndrome (HRS) |
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Definition
slower onset; survival time < 6 months if left untreated |
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Term
Hepatorenal Syndrome Txts |
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Definition
Liver +/- kidney transplant; Octreotide + midodrine; albumin; limited studies for vasopressin +/- Octreotide |
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Term
Liver +/- kidney transplant in HRS |
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Definition
50-60% 5 year survival rate; Transjugular Intrahepatic Postsystemic Shunt (TIPS) --> 35% 18 month survival |
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Term
Octreotide + midodrine for HRS |
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Definition
titrated to increase mean arterial blood pressure at least 15 mmHg |
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Term
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Definition
use high concentration (20-25%) formulation; high cost; combo with octreotide + midodrine loosely 1st line in US |
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