Term
Management of Ascites
1) Start with non-pharm
2) Pharm |
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Definition
Management of Ascites
First - If respiratory difficulty: TAP 3-4 L?
1) Start with non-pharm:
Restrict sodium to 2 grams per day
restrict fluids to 1.5L/day
2) Pharm:
Spironolactone, if no improvement, add furosemide, if no improvement, and metolazone, if no improvement, continue diuretics, then perform large volume abdominal paracentesis, and administer albumin 25g IV for every 3 liters of fluid removed. |
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Term
SE's of spironolactone?
Viable substitute for it? |
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Definition
SE's of spironolactone: gynecomastia, hyperkalemia
Substitute with Amilioride |
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Term
Treatment of Spontaneous Bacterial Peritonitis:
When is prophylaxis indicated? What is the prophylaxis? |
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Definition
Treatment of Spontaneous Bacterial Peritonitis:
3rd gen cephalosporin for 5 days, and IV albumin
Prophylaxis indicated in 1 previous episode of SBP with severe liver disease, and a protein level of <15g/L.
Prophylaxis is : SMX/TMP or Norfloxacin or ciprofloxacin |
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Term
| Hepatic Encephalopathy Treatment |
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Definition
Lactulose to achieve 2-3 loose stools/day
if no improvement within 24-48h, add metronidazole |
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Term
| Cholestatic Disease treatments |
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Definition
| UDCA + Vitamins + Cholestyramine (if pruritis) + Naltrexone or rifampin or sertraline if Pruritis is not improving with cholestyramine |
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Term
| Chronic Active Hepatitis Treatment |
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Definition
Corticosteroids + Azathioprine
Mycophenolate can be used if azathioprine is not tolerated |
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Term
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Definition
Pentoxifylline or corticosteroids
Pentoxifylline found to be superior |
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Term
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Definition
| Phlebotomy, or if unable to tolerate chelation with deferoxamine |
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Term
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Definition
Lifelong Trientine or penicillamine.
Should give pyridoxine with penicillamine to counteract its antipyridoxine effects |
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