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