Liver Disease tutoring Part 2 By Alaina Darby

JR is 44 yo wm with a history of alcohol abuse and cirrhosis JR is 44 yo wm with a history of alcohol abuse and cirrhosis. Which of the following is the most likely lethal complication in this patient? Encephalopathy Coagulopathy Variceal bleeding Ascites c

JR is 44 yo wm with a history of alcohol abuse and cirrhosis JR is 44 yo wm with a history of alcohol abuse and cirrhosis. His hr is 94 and bp is 120/80 and HVPG is 13. What should be done now? Give fluids EGD Give nadolol Give propranolol b

JR is 44 yo wm with a history of alcohol abuse and cirrhosis JR is 44 yo wm with a history of alcohol abuse and cirrhosis. His hr is 94 and bp is 120/80 and HVPG is 13. His EGD shows varices. What should be done now? Give propranolol PO to target HR <100 Give propranolol PO to target HPVG <12 Give propranolol IV to target HR <100 Give propranolol IV to target HPVG <12 b… primary prophylaxis!!

JR is 44 yo wm with a history of alcohol abuse and cirrhosis JR is 44 yo wm with a history of alcohol abuse and cirrhosis. He has developed bloody emesis. Now His hr is 122 and bp is 100/62 and HVPG is 13. What should you do first? Give antibiotics Give vasopressin EGD Give fluids d

JR is 44 yo wm with a history of alcohol abuse and cirrhosis JR is 44 yo wm with a history of alcohol abuse and cirrhosis. He has developed bloody emesis Now His hr is 122 and bp is 100/62 and HVPG is 13. his bp corrects to 128/89 with fluid administration. What should you use as pharmacological management? Give antibiotics + octreotide + nitroglycerin Give antibiotics + vasopressin + nitroglycerin Give octreotide + nitroglycerin Give octreotide + vasopressin b

JR is 44 yo wm with a history of alcohol abuse and cirrhosis JR is 44 yo wm with a history of alcohol abuse and cirrhosis. He has developed bloody emesis Now His hr is 122 and bp is 100/62 and HVPG is 13. his bp corrects to 128/89 with fluid administration. Which of the following antibiotics would you consider? Cetriaxone 1g IV Q day Norfloxacin 400mg IV Q12 Ciprofloxacin 400mg PO BID Levofloxacin 500mg PO BID a

JR is 44 yo wm with a history of alcohol abuse and cirrhosis JR is 44 yo wm with a history of alcohol abuse and cirrhosis. He has developed bloody emesis Now His hr is 122 and bp is 100/62 and HVPG is 13. his bp corrects to 128/89 with fluid administration. How long should he receive antibiotics? 3 days 7 days 10 days 28 days b

JR is 44 yo wm with a history of alcohol abuse and cirrhosis JR is 44 yo wm with a history of alcohol abuse and cirrhosis. He has developed bloody emesis Now His hr is 122 and bp is 100/62 and HVPG is 13. his bp corrects to 128/89 with fluid administration. Which of the following would be preferred if he has a history of hypertension? Octreotide x 24 hours Vasopressin x 24 hours Octreotide x 72 hours Vasopressin x 72 hours c

JR is 44 yo wm with a history of alcohol abuse and cirrhosis JR is 44 yo wm with a history of alcohol abuse and cirrhosis. He has developed bloody emesis Now His hr is 122 and bp is 100/62 and HVPG is 13. his bp corrects to 128/89 with fluid administration. Which of the following would be preferred if he has a history of diabetes? Octreotide x 24 hours Vasopressin x 24 hours Octreotide x 72 hours Vasopressin x 72 hours b

JR is 44 yo wm with a history of alcohol abuse and cirrhosis JR is 44 yo wm with a history of alcohol abuse and cirrhosis. He has developed bloody emesis Now His hr is 122 and bp is 100/62 and HVPG is 13. his bp corrects to 128/89 with fluid administration. Which of the following might be preferred if his hr dips to 54 and he has a history of hypertension? Octreotide x 24 hours Vasopressin + NTG x 24 hours Octreotide x 72 hours Vasopressin + NTG x 72 hours b

JR is 44 yo wm with a history of alcohol abuse and encephalopathy due to cirrhosis. He has developed bloody emesis Now His hr is 122 and bp is 100/62 and HVPG is 13. his bp corrects to 128/89 with fluid administration. Which of the following would be least preferred method of treatment? Pharmacological EVL TIPS Sclerotherapy c

JR is 44 yo wm with a history of alcohol abuse and encephalopathy due to cirrhosis. After his variceal hemorrhage is treated with propranolol and shunt, what should he receive for prophylaxis? TIPS procedure EVL Nadolol Prophylaxis not indicated c

Which of the following is true? SAAG of 2.1 indicates another cause of ascites SAAG of 1.5 indicates another cause of ascites SAAG of 1.5 indicates portal HTN-induced ascites SAAG of 0.9 indicates portal HTN-induced ascites c

Which of the following is true? SAAG of 1.5 indicates increased serum and/or increased ascetic albumin SAAG of 1.5 indicates decreased serum and/or increased ascetic albumin SAAG of 1.5 indicates increased serum and/or decreased ascetic albumin SAAG of 1.5 indicates decreased serum and/or decreased ascetic albumin c

RO has ascites and liver failure. SAAG is 1. 0 and Na+ 118 RO has ascites and liver failure. SAAG is 1.0 and Na+ 118. How should this patient be managed initially? Na+ restriction Fluid restriction Paracentesis Liver transplant b

RO has ascites and liver failure. SAAG is 1. 0 and Na+ 118 RO has ascites and liver failure. SAAG is 1.0 and Na+ 118. How should this patient be managed if fluid restriction is not effective for relieving ascites? Evaluate kidney function Evaluate cardiac function Paracentesis Liver transplant a & b

jr has ascites and liver failure. SAAG is 2. 0 and Na+ is 140 jr has ascites and liver failure. SAAG is 2.0 and Na+ is 140. How shouldn’t this patient be managed? Alcohol abstinence Fluid restriction Sodium restriction Diuretic therapy a

jr has ascites and liver failure. SAAG is 2. 0 and Na+ is 140 jr has ascites and liver failure. SAAG is 2.0 and Na+ is 140. What is the preferred diuretic(s)? Furosemide HCTZ HCTZ + spironolactone Furosemide + spironolactone d

jr has ascites and liver failure. SAAG is 2. 0 and Na+ is 140 jr has ascites and liver failure. SAAG is 2.0 and Na+ is 140. you start her on Furosemide and Spironolactone. When would you discontinue it? SCr 1.8 Ammonia increases Na+ 118 Ascites resolves a

jr has ascites and liver failure. SAAG is 2. 0 and Na+ is 140 jr has ascites and liver failure. SAAG is 2.0 and Na+ is 140. you start her on Furosemide and Spironolactone. The medication is not working and you decide that paracentesis is warranted. How much albumin should you administer if you remove 3l of fluid? none 8g 24g 64g a

jr has ascites and liver failure. SAAG is 2. 0 and Na+ is 140 jr has ascites and liver failure. SAAG is 2.0 and Na+ is 140. you start her on Furosemide and Spironolactone. The medication is not working and you decide that paracentesis is warranted. How much albumin should you administer if you remove 8l of fluid? none 8g 24g 64g c

jr has ascites and liver failure. SAAG is 2. 0 and Na+ is 140 jr has ascites and liver failure. SAAG is 2.0 and Na+ is 140. you start her on Furosemide and Spironolactone. The medication is not working and fluid quickly accumulates after paracentesis. What should you do immediately? TIPS Peritoneovenous shunt Add midodrine Liver transplant c

jr has ascites and liver failure. SAAG is 2. 0 and Na+ is 140 jr has ascites and liver failure. SAAG is 2.0 and Na+ is 140. you start her on Furosemide and Spironolactone. The medication is not working and fluid quickly accumulates after paracentesis. Now she has an infection in her ascetic fluid. Which of the following types of microbes is it most likely? Aerobic gram negative Aerobic gram positive Anaerobic gram negative Anaerobic gram positive a

jr has ascites and liver failure. SAAG is 2. 0 and Na+ is 140 jr has ascites and liver failure. SAAG is 2.0 and Na+ is 140. you start her on Furosemide and Spironolactone. The medication is not working and fluid quickly accumulates after paracentesis. Now she has an infection in her ascetic fluid. Which of the following types of microbes is it most likely? Aerobic gram negative Aerobic gram positive Anaerobic gram negative Anaerobic gram positive a

jr has ascites and liver failure. SAAG is 2. 0 and Na+ is 140 jr has ascites and liver failure. SAAG is 2.0 and Na+ is 140. you start her on Furosemide and Spironolactone. The medication is not working and fluid quickly accumulates after paracentesis. Now she has an infection in her ascetic fluid. How should it be treated? Ceftriaxone 2g IV Q24 Ceftriaxone 2g IV Q12 Ceftriaxone 1g IV Q24 Ceftriaxone 1g IV Q12 d

jr has ascites and liver failure. SAAG is 2. 0 and Na+ is 140 jr has ascites and liver failure. SAAG is 2.0 and Na+ is 140. you start her on Furosemide and Spironolactone. The medication is not working and fluid quickly accumulates after paracentesis. Now she has an infection in her ascetic fluid. When should you stop treatment? 5 days 10 days PMNs >250 PMNs <250 a… don’t usually repeat paracentesis

jr has ascites and liver failure. SAAG is 2. 0 and Na+ is 140 jr has ascites and liver failure. SAAG is 2.0 and Na+ is 140. you start her on Furosemide and Spironolactone. The medication is not working and fluid quickly accumulates after paracentesis. Now she has an infection in her ascetic fluid. Would this patient be indicated for prophylaxis? Yes, ceftriaxone 1g Q day Yes, norfloxacin 400mg Q day Yes, Bactrim DS Q day No b

AH is a 73 yo wf who was previously diagnosed with liver failure comes in to pick up her prescriptions. She is currently taking docusate, Xanax, and aspirin. She also drinks a significant amount of ensure. You notice that she seems a little more confused than normal. Which of the following would be least important to evaluate? Protein intake Bowel movements Ammonia level GI integrity c

AH is a 73 yo wf who was previously diagnosed with liver failure comes in to pick up her prescriptions. She is currently taking docusate, Xanax, and aspirin. She also drinks a significant amount of ensure. You notice that she seems a little more confused than normal. Which of the following might complicate a diagnosis of hepatic encephalopathy? Xanax use Development of asterixis Increased protein intake High ammonia levels a

AH is a 73 yo wf who was previously diagnosed with liver failure comes in to pick up her prescriptions. She is currently taking docusate, Xanax, and aspirin. She also drinks a significant amount of ensure. You notice that she seems a little more confused than normal. Which of the following would you not want to recommend to correct underlying issues? Discontinue/reduce Xanax dosage Discontinue/reduce ASA dosage Discontinue/reduce Ensure Discontinue/reduce docusate dosage d

Ammonia… Increased Availability Decreased Clearance Other (not ammonia) Dietary protein (production) Renal (excretion) Psych meds (altered baseline) GI hemorrhage (release) Constipation (excretion) Infection (production) Liver function (metabolism)

AH is a 73 yo wf who was previously diagnosed with liver failure comes in to pick up her prescriptions. She is currently taking docusate, Xanax, and aspirin. She also drinks a significant amount of ensure. You notice that she seems a little more confused than normal. What he category would she fall into at this time? Grade I Grade II Grade III Grade IV a

AH is a 73 yo wf who was previously diagnosed with liver failure comes in to pick up her prescriptions. She is currently taking docusate, Xanax, and aspirin. She also drinks a significant amount of ensure. You notice that she seems a little more confused than normal. Which of the following pharmacological therapies would you most likely consider? Lactulose Neomycin Rifaximin Metronidazole a

AH is a 73 yo wf who was previously diagnosed with liver failure comes in to pick up her prescriptions. She is currently taking docusate, Xanax, and aspirin. She also drinks a significant amount of ensure. You notice that she seems a little more confused than normal. Which of the following might you be able to discontinue with lactulose therapy? ASA Xanax Ensure Docusate d

AH is a 73 yo wf who was previously diagnosed with liver failure comes in to pick up her prescriptions. She is currently taking docusate, Xanax, and aspirin. She also drinks a significant amount of ensure. You notice that she seems a little more confused than normal. Why might you use rifamixin in addition to lactulose? Decrease dizziness Decrease drug interaction Decrease abdominal cramping Decrease peripheral edema c

AH is a 73 yo wf who was previously diagnosed with liver failure comes in to pick up her prescriptions. She is currently taking docusate, Xanax, and aspirin. She also drinks a significant amount of ensure. You notice that she seems a little more confused than normal. When her symptoms resolve, should she receive prophylaxis? If so, what? No Yes, lactulose Yes, rifamixin Yes, neomycin c

Which of the following would be indicative of increased bleed risk in liver failure? Low levels of factor II Vitamin K deficiency Low level of protein C Increased NO production Elevated INR 2 of the above 3 of the above 4 of the above All of the above g… a, b, and d

Which of the following would be least likely to trigger hepatorenal syndrome? Variceal bleed Paracentesis Infection Rapid diuresis d

Which of the following patients would you treat with albumin + norepinephrine? SCr 2.4 (baseline 1.2), BP 98/65 SCr 2.4 (baseline 1.2), BP 128/95 SCr 2.8 (baseline 1.2), BP 98/65 SCr 2.8 (baseline 1.2), BP 128/95 c

Which of the following would you give to both type 1 and type 2 HRS patients? Terlipressin Midodrine Albumin Octreotide c

Which of the following is the best first-line option for HPS management? Liver transplant Lung transplant Albuterol Albumin a