- Shuffle
Toggle OnToggle Off
- Alphabetize
Toggle OnToggle Off
- Front First
Toggle OnToggle Off
- Both Sides
Toggle OnToggle Off
Front
How to study your flashcards.
Right/Left arrow keys: Navigate between flashcards.right arrow keyleft arrow key
Up/Down arrow keys: Flip the card between the front and back.down keyup key
H key: Show hint (3rd side).h key
PLAY BUTTON
PLAY BUTTON
281 Cards in this Set
- Front
- Back
|
define nausea
|
inclination to vomit
|
|
define retching
|
rhythmic contractions
|
|
T or False
Regurgitation does not equal vomiting |
True
|
|
what are the 4 indications for TPN
|
complete intestinal obstruction
ileus severe intractable diarrhea Initial SBS |
|
what are the other 5 indications
|
radiation enteritis
acute GI bleeding high output fistula acute pancreatitis hemodynamic instability |
|
what 2 things complicate a central line in TPN?
|
pneumothorax
infection |
|
Esophagus is what kind of tissue
|
stratified squamous
|
|
what is critical for development of esophageal mucosal injury?
|
gastric juices
|
|
GERD causes....
|
Erosion, ulceration, bad taste, pneumonitis
**Barretts esophagitis **Adenocarcinoma |
|
define Barretts disease
|
distal squamous mucosa replaced by metaplastic columnar epithelium
|
|
why is squamous tissue replaced by columnar epithelium
|
because it is more resistant to gastric acid
|
|
how do you diagnosis Barretts
|
endoscopic evid. of column. epithelium ABOVE the gastroesphageal junction
must be histologic evidence of intestinal metaplasia |
|
what are the 2 criteria for Barretts?
|
columnar epithelium
intestinal metaplasia |
|
Barretts is a precursor for what?
|
adenocarcinoma
(which is preventable) |
|
define acute gastritis
|
inflam. of gastric mucosa
-predominantly neutrophilic infiltrate(PMNs) |
|
define chronic gastritis
|
same as acute but minaly MONOnuclear
|
|
primary causes of acute gastritis
|
heavy NSAID use
Increase in EtoH use |
|
primary causes in chronic gastritis
|
H. Pylori
Gastric hyperacidity |
|
describe H. pylori
|
causes chronic gastritis
Gram neg rod, motile produces Urease-protects bug from acid Does not invade-it superfical colonizes by adhesion |
|
define ulcer
|
break in mucosa(anywhere)
extends thru muscularis mucosa into submucosa or DEEPER |
|
put in order from inner to outer
submucosa muscularis mucosa mucosa |
mucosa
Muscularis mucosa submucosa(where blood vessels are) |
|
what is the most important factor in Peptic Ulcer Disease
|
H. Pylori
|
|
how does H. pylori cause damage?
|
produces proteases and phospholipases-break down epithelial cells-->ulcer
|
|
what are main characteristics of Peptic Ulcers?
|
Duodenum
lesser curvature body/antrum |
|
main characteristics of Duodenal ulcers?
|
acid hyposecretion
rapid gastric emptying |
|
what are the complications seen in peptic/duodenal ulcerS?
|
obstruction(most common)
malignant change hemorrhage perforation |
|
malignant change mostly seen in which type of ulcer?
|
rare in DU
mainly GU |
|
Crohns is mainly seen where?
|
anywhere in GI
|
|
Ulcerative Colitis seen where?
|
ONLY large intestine
|
|
Crohns and colitis common symptoms
|
infection
abnormal host immunoreactivity inflamm. |
|
Crohns symptoms
|
relapsing, inflam., GRANULOMAS
often small intestine + colon-but can be ANYWHERE |
|
describe Crohns type of inflam?
|
transmural inflam->entire wall
-noncaseating granulomas -mononuclear(macroFAGS) |
|
desribe what Crohns looks like
|
skiplessions
cobblestone linear ulcers |
|
clinical signs of crohns
|
stricture formation
intestinal obstruction fistula prenicou anemia steatorrhea |
|
what is steatorrhea?
|
can't absorb fats->go thru large colon
|
|
desribe ulcerative colitis
|
relapsing, inflam
NON-granulomatus limited to the colon |
|
ulcerative colitis characteristics
|
continuous extension from rectum
retrograde progession psudeopolyps, crypt abcesses, submucosal fibrosis **serosa NOT involved** |
|
what is seen in colorectal carcinoma
|
polyps
|
|
what are the 2 type of polyps
|
hyperplastic-no malignant potential
adenomatous-exhibit dysplasia, precursors for carcinoma |
|
where does adenomatous grow?
|
on stocks(pedunuclated)
on mucosa(sessile) |
|
molecular pathogeneis of adenomatus polyps
|
abnormal tumor suppressor genes
genes resp. for repairing DNA |
|
most cancers are in which part of intestine
|
sigmoidal>ascending> other
|
|
proximal tumors
|
polypoid
exophytic no obstruction, easily bleed anemia |
|
positive fecal occult blood test results in what color?
|
blue=iron in blood
|
|
distal tumor characteristics
|
annular, encircling
Napkin ring constriction change in bowel habits hematochezia desmoplastic |
|
dfine hematochezia
|
bright red blood in stool->more bright means closer to rectum
|
|
define demoplastic
|
firm outside of tumor
|
|
Best ways to diagnosis colon tumors
|
colonoscopy-->Fe deficency-->CEA(carcinoembryonic antigen)
|
|
characteristics of cirrhosis of liver
|
YES U R FUCKED CRAIG
bridging fibrous septa parenchymal nodules |
|
what caues the fibrous tissue in cirrhosis
|
EtoH
chronic viral Hepatitis |
|
what is the central pathogenic process in cirrhosis?
|
progessive fibrosis
|
|
what cell produced the fibrous tissue
|
Hepatic Stellate cell
|
|
what activates the Stellate cell?
|
toxins
cytokines disruption of extracellular matrix |
|
describe hepatic steatosis
|
fatty liver
can be reversible |
|
describe alcoholic hepatitis
|
inflam.
|
|
describe alcoholic cirrhosis
|
deposition of fibrous tissue that does NOT go away
PERMANENT-like Craigs AIDS |
|
3 features of cirrhosis
|
hypoalbuminemia
gynecomastia spider angiomata |
|
define acute pancreatitis
|
acute onset of abdominal pain from enzymatic necrosis + inflam.
releasing enzymes into extracell. space |
|
clinical signs of pancreatitis
|
increases in lipases and amylases
|
|
severe signs of pancreatitis
|
DIC-blood clots everywhere
shock acute renal tubular necrosis |
|
2 signs of pancreatic cancer
|
couvosier sign
trousseau sign |
|
define couvosier sign
|
paliable destended gallbladder
|
|
define troussea sign
|
migratory thromboplebitis
|
|
tumor markers
|
c19-9->specific for pancreas
|
|
what are the symptoms of chronic dyspepsia
|
epigastric pain
N/V |
|
2 common causes of PUD
|
H. pylori
NSAIDS |
|
H. pylori is listed as a?
|
carcinogen
|
|
H. pylori secretes catalase, which does what
|
inactivates our neutrophils
|
|
H. pylor vs NSAID
ulcer depth |
HP-superfical
NSAID-DEEP |
|
HP vs NSAID
-histology -pain |
HP-chronic inflam.
NSAID-no inflam HP-pain NSAID-pain, but can be asymptomatic |
|
GI bleeding is more severe in which cause of ulcer ?
|
NSAID induced-life threatening
|
|
what are the alarm symptoms for PUD
|
Weight LOSS
bleeding dysphagia chest pain |
|
Endoscopy does what?
|
visualizes ulcer and can biopsy to detect for HPI
|
|
fecal antigen test
|
noninvasive
tests for HP antibodies used for verification of eradication of HP |
|
Urea Breath Test
|
noninvasive
HP secretes urease which hydrolyzes a labeled C->>pt exhales the labeled CO2 -if labeled co2 is exhaled-HP is present |
|
CLO test
|
detects HP-urease causes medium to turn red
|
|
campylobacter means?
|
curved bacteria
|
|
helicobacter means?
|
spiral or helical bacteria
|
|
first line Tx of HPI eradication
|
PPI + clarithromycin +amoxil/metro/tetra for 2 weeks
|
|
which PPI is not approved for HP tx
|
pantoprazole or desomeprazole
|
|
why are antibiotics comboed with PPIs for HP eradication?
|
PPI dec. gastric acid volume, which increased antibiotic
|
|
which antibiotic should be used once in HP eradication>?
|
clarithromycin-bugs become resistant to drug quickly
|
|
Drug resist. is rare in which antibtiotics for HP tx?
|
amoxicillin
tetracycline (metro needs to be increased if used more than once) |
|
Risk factors for NSAID-ulcers
|
prior ulcer
age >65 high NSAID use (duh) ASA at same time-doesnt matter form SSRI, bisphosphates, plavix |
|
1-2 RF for NSAIDs whats tx?
Moderate GI low cardiac |
NSAID + PPI or misoprostil
|
|
>3RF for NSAID whats tx?
high GI low cardiac |
tramadol, opoids
celebrex +PPI/misoprostil |
|
moderate GI, high CV risk tx?
|
Naproxen +PPI/ misoprostil
|
|
NSAID ulcer tx for
High GI/High CV risk |
avoid NSAIDS
Need PPI |
|
which drug is safest for cardio problems in ulcers
|
Naproxen
|
|
whats in vimovo
|
naproxen and esomeprazole
|
|
tx for NSAID ulcer
DU vs GU |
DU-4 weeks of PPI
GU-8weeks of PPI |
|
which drug keeps the pH higher longer?
|
PPI>H2
|
|
PPI facts
|
inhibits H+/K+ atpase
-NO dosage adj. for renal Preg Cat. B except Omeprazole |
|
omeprazole is what category
|
C-so use with caution during lactation
|
|
all PPI's provide same...
|
healing rates
maintenance of healing relief of symptoms |
|
PPIs do what to clarithromycin
|
reduces the degradation of the acid-liable drug
-keeps drug around longer |
|
NSAID ulcers
if pt is bleeding on aspirin what should be given? |
use aspirin + PPI
DO NOT switch to plavix |
|
S.E. of PPIs
|
infectious diarrhea ->C. diff ->if so, stop use and give antibiotic
Hip fractures H.A. |
|
H2 antag facts
|
inhibit acid secretion by histamine
ALL req. dose adjus. for renal imp. Preg. B-watch in lactation |
|
what is H2 antag. not used for
|
not used for preventing a GU due to NSAIDS
|
|
H2 antag use
|
DU-standard dose
GU-double dose needed relieves dyspepsia |
|
Misoprostil
MOA Cautions |
moa-prostaglandin analog
-protects mucosa Cautions-Preg Cat. X |
|
Misoprostil efficacy?
|
reduces riask of increasing complications + ulcers
causes diarrhea(start low then incr.) |
|
sucralfate
better for? when to use? |
best for DU
lastline |
|
define GERD
|
reflux of stomach contents back into esophagus
-pt does NOT make extra acid |
|
defineNERD
|
Neg. Endo. reflux disease
-usually dont respond to PPIs |
|
define EE
|
erosive esophagitis
inflam. with visable damage on endoscopy |
|
pathophysio in GERD
|
decrease in LESP allows contents to move up
pressure ABOVE les usually higher then stomach to prevent upflow |
|
what can weaken the LES?
|
estrogens, CCB + BB, and fatties/pregnant women increase pressure behind the stomach
|
|
clinical presentation of GERD
|
heartburn
regurg. N/v belching/hiccups |
|
lifestyle mods for GERD
|
3 small meals
eat slow lots of water dont lay down after meals DON'T USE PILLOWS(just elevate head 6 inches) |
|
Tx:
if GERD symptoms <2days/week ig >2 days/week |
<2days/week- OTC antacids, H2B, Prilosec
>2days- Rx dose of H2B,OTC prilosec -LIFESTYLE MOD. ALWAYS |
|
severe GERD sympt. Tx with?
|
PPI
LIFESTYLE MOD. ALWAYS |
|
Antacid disadv.
|
no esophageal healing
doesnt neutralize at night |
|
alginic acid
|
helps with nighttime heartburn
causes refluxing of viscous sodium alginate |
|
H2Bs
adv. disadv. |
adv-last for 6-10hours
dis-no increase in LES tone or decrease in freq. of GERD develop tol. in 5 days |
|
indication for PPI tx
|
heartburn >2 days/week
use for 8-16 weeks(usually lifelong) try for 6 months before considered failure |
|
metoclopramide adv
|
prokinetic agent
increases LES pressur increases esophageal peristalsis |
|
metoclopramide disadv.
|
minimal healing
altered mental status(CNS changes) |
|
what is the DOC for pt with GERD and healed esophagitis
|
PPI
|
|
CTZ senses?
responds via? |
senses toxins
reports via 5-ht3, D, Neurokinin-1 |
|
enterocromaffin cells sense?
responds via? |
sesnse damage
respond directly->serotonin indirectly-> vagal afferent stim |
|
vestib. system sesnse?
responds? |
senses balance and propioception
responds by Ach and histam. |
|
Know the Path slide in N/V**
|
**
|
|
simple vs complex vomiting
|
simple-symptomatic Tx only
-Labs:none complex-fluid/elect. imbalance -psychogenic causes |
|
Antacids use?
ADE? |
simple NV-from heartburn, overeating Q2-4 hours
ADE-diarrhea(Mg) or constip. |
|
H2 Antag.
|
BID
simple N/V from heartburn/GERD |
|
causes for motion sicknes?
|
infection, injury, malignancy
|
|
scopolamine is ______ antihistamines
|
> or =
|
|
S.E. for Scopolamine
|
dry mouth, drowsiness, blurred vision
|
|
what are medications used for motion sickness?
|
anticholinergics and antihistamines
Phenothiazines |
|
why arn't claritin or zyrtec used in motion sickness?
|
no drowsiness activity
|
|
Phenothiazines
actions? used for? ADE? |
actions-D2 antag., anticholinergic
used for breakthrough ADE-more risk than other therapies-excessive sedation |
|
PONV RIsk factors?
|
**NONsmoking**
Female history of motion sickness/PONV anesthetics-opoids/N02 long surgery (>60mins) |
|
how many drugs per risk factors
|
0-1; no meds
2+; prophylaxis 1-2 meds (4-5)high risk pts will recieve 3 drugs |
|
when should 5-HT3s be given?
|
at END of surgery
|
|
5HT3 -which is longest acting?
ADE? |
palonisteron
H.A., constip.->no bad CNS ones |
|
Droperidol
actions? ADE.? |
blocks dopiminergic CTZ stim.
QT prolongation and torsades de pointes |
|
Corticosteroids for N/V
which drugs? when to give? mech? |
dexamethasone, methypred.
**give at anesthetic introduction** unkown mech |
|
aprepitant
when to give? how does it work? interactions? |
3 hours before induction
NK1 antag, inhib GI + CTZ mess. 3A4 inhibitor 2CP inducer |
|
what should be done to dexamethasone if takenwith aprepitant?
|
decrease dexam. dose by half if co-admin.
|
|
Metoclopramide
actions? ADE? |
anti-D2 in CTZ
prokinetic agent: inc. motility ADE-acute dystonic reactions(25%), tardive dyskinesia, psuedoparkinsonism |
|
when should dose be adjusted with metoclopramide
|
when pt has kidney problems
-renal adjustment needed** |
|
when does acute N/V take place in CINV pts?
delayed? |
acute-within 24 hours
delayed-onset after 24 hours peaks in 2-3days |
|
breakthrough meds?
what if they didnt work for prophylaxis? |
metoclopramide, phenothiazines, FHT3
use meds with diff MOA |
|
CINV drugs rated by?
pts recived what regimen? |
rated by emetogenic risk
get prophylaxis + breakthrough |
|
RINV risk varies by?
|
area of radiation
|
|
high risk of 90%
radiation area? recc? |
total body
prophylaxis with 5-HT3A + dexamethasone |
|
low risk of <30%
radiation area? recc? |
head, neck, breast
5HT3 antag |
|
what is hyperemesis gravidarum?
|
hyper emesis while pregnant.
|
|
guidelines for emesis in pregnancy from?
|
ACOG-college of obstericians + gynecologists
|
|
N/V in preg.
start with? 1st line? 2nd? 3rd? |
take multivitamin
1st-Vit B6 pyridoxine +/- doxylamine 2nd-diphenhydramine 3rd-phenothiazines, metoclopramide |
|
severe N/V in preg tx?
|
hyperemesis gravidarium
tx-IV hydration corticosteroids for REFRACTORY only supp nutrition-enteral |
|
What is the caloric requirement for dextrose?
|
20-30 cal/kg
|
|
what are caloric requirements for proteins in normal renal function?
renal/hepatic insuff? |
1-2g/kg
0.6-0.8 g/kg |
|
glucose caloric values?
protein? |
4cal/g
4cal/g |
|
what is the optimal hangtime for TPN in immune compromised?
normal? |
immune comp-24H
reg.-12H shorter times mess with mactophages |
|
what is kwashiorkor?
marasmus? |
2 types of malnutrition
k-albumin is depleated-more visceral m-decrease in skel. muscle |
|
what values do you look for in kwashikor/marasmus
|
albumin-19 day t1/2
prealbumin-3 day(nutriton indicator) |
|
Enteral feeding-gen info
|
better for gut
cheaper gastric or jejunal |
|
gastric vs jejunal
pros/cons |
gastric-have to check residuals q 6-8H(whats left instomach)
jejunal-no residual checking, no aspiration prob. but check for diarrhea |
|
problems with parenteral
|
pneumothorax
gut doesnt get nourishment |
|
central vs peripheral
mOsm? SE? |
central->1000-2000 mOsm
more calories peripheral-only 1000 mOsm Phlebitis risk |
|
what is a PICC line?
|
central line via peripheral route
|
|
refeeding syndrome
|
check *Mg*, K, *Phosphate*
check d for first 4 days Mg levels need to be corrected first |
|
in pulmonary dysfun. what is the dextrose limit?
|
do not exceed 5-7 mg/kg/min
if its more it causes a greater increase in CO2 |
|
what is preferred route of TPN in pulm dysfun?
|
enteral
|
|
which two drugs have calories and whats the percent?
|
profolol and ampoterrible
10% |
|
preferred feeding route in pancreas dysfun?
|
enteral-jejunal-bypasses stomach
give elemental formulas |
|
how are lipids given in pancreas dysfunction?
how often |
parenteral
3 times a week |
|
what is the preferred feeding route in renal dysf?
considerations to watch? |
enteral
insulin resistance, use carbs in caution mots pts are diabetic |
|
protein values for renal
non-dialyzed dialyzed |
nond-0.6-0.8 g/kg
****d-1-1.5 g/kg*** |
|
what is the caloric content of dextrose in renal
lipids need dosage adjust? |
20-25 cal/kg
No adjust needed |
|
SBS preferred route?
protein values |
enteral
1.5-2g/kg |
|
calories for SBS
fluids? |
20-30 cal/kg
1cc/cal |
|
what are 2 requirements to not be on TPN for rest of life?
|
>100 cm and the ileocecal valve
|
|
trauma info
calories |
chunkies-wait up to 7 days before feeding
matties-enteral feeding STAT 20-25 cal/kg |
|
what is K electrolyte requirements?
|
1-2 mEq/kg
|
|
what is Na electrolyte requirements?
|
1-2 mEq/kg
|
|
what is Ca electrolyte requirements?
|
10-15 mEq/DAY
NOT weight based |
|
what is Mg electrolyte requirements?
|
8-20 mEq/DAY
NOT weight based |
|
what is phosphate electrolyte requirements?
|
20-40 mmol/DAY
NOT weight based |
|
hyperglycemia in TPN
hypoglycemia |
add 2/3 of insulin units given previous day to present TPN
give ampule of D50 Hang bag of D10 stop TPN bag |
|
Na range
hypoNa tx hperNa tx |
135-145
hypo-fluid restrict, give 3%NaCl vasoprosol hyper-add free water to TPN remove Na |
|
K range
hypoK tx hyper K tx |
3.5-5
hypo-Add K(bolus) hyperK-remove K kayexalate dialysis |
|
Phosphate range
hypo tx hyper tx (dumb card) |
2.5-4.5
hypo-add PO4(bolus) hyper-remove PO4 dialysis |
|
Ca range
what form? hypo tx hyper tx? |
1.12-1.23
ionized hypo-add Ca(bolus) hyper-remove Ca from TPN dialysis |
|
Mg range?
|
1.6-2.3 mg/dl
hypo-Mg bolus hyper-dialysis 2.7mg/dl |
|
Vitamin A is for?
def? |
vision
get this wrong=kicked outta pharm -night blindness |
|
Vit B1 aka
def? |
thiamine
coenzyme in the pentose pathway def-Beriberi->causes wenickes encephalopathy |
|
Vit B2 aka
def? |
riboflavin
dermatitis and stomatitis |
|
vit B3 aka
def? |
niacin
def-pellagra(black tongue) |
|
Vit B6 aka
def? |
pyridoxine
depression, dermatitis |
|
vit B12 aka
def? |
cyanocobalamin
def-megaloblasic anemia, leukopenia, thrombocytopenia |
|
Vit C aka
def? does what? |
ascorbic acid
def-scurvy antioxidant |
|
what is good for wound healing?
|
Vit C + Zinc
|
|
what is Vit C required for?
|
for reductive protection of folic acid and Vit E
|
|
Vit E use
def? |
antioxidant by trapping peroxyl free radicals in cell membranes
def-inc. platelet agg./anemia |
|
folic acid
def? |
water soluble
megaloblastic/macrocystic anemia |
|
Iron
def? |
trace element
anemias |
|
Zinc def
|
growth retardation
bad night vision alt. in taste/smell |
|
Chromium
|
trace element
potentiates the action of insulin |
|
acetate vs chloride
|
acetate-converted to bicarb to increase pH-for acidonic pt
chloride-converted to acid to decrease pH for alkalosis |
|
liver recieve blood from
|
2 systems
hepatic artery portal vein |
|
whats in the splanchnic blood
|
oxygen poor
nutrient rich blood |
|
function of liver?
|
synthesis of albumin, coag factors
detox of ammonia, billirubin regulation of horomones |
|
diseases of liver
|
immune/autoimmune
alcholic liver disease cholestatic syndromes |
|
3 mech that damage the liver
|
hepatocellular necrosis
cholestatic injury vascular damage |
|
define cirrhosis
|
presence of fibrosis tissue replacement
|
|
clinical presentation of liver disease
|
jaundice
N/V abdominal distentioon gynecomastia spider angiomas |
|
Risk factors for liver disease
|
female>male
>6drinks/day highly sexual |
|
2 drug-induced liver diseases
|
methyldopa
amiodarone |
|
LFT's
|
ALT, AST
it reflects the health of the liver NOT the FUNCTION |
|
ALT
what happens in liver disease? normal value? |
rises dramatically in acute
5-40 |
|
AST
what happens in liver damage normal value? |
rises
10-40 |
|
TBIL
normal value |
breakdown product of heme
0.1-1 measures conjug. vs unconjug |
|
GGTP
normal value function |
0-51
specific to the liver marker for cholestatic damage |
|
ALP
normal value? function |
24-110
ezymes in the cells lining the biliary ducts(in cholestatic) drawn with GGTP |
|
LDH
|
200-300
rises in tissue breakdown NOT an indicator of liver disease |
|
Child-Pugh score
|
determines the functionality of the liver
|
|
elevated AST/ALT usually means?
|
hepatocellular
|
|
elevated ALP, GGTP, TBIL usually?
|
suuspect cholestatic
|
|
pathogenesis in alcholics
|
deficiency of protein calories, def of vit B1->wernickes encephalopathy
|
|
patho in biliary cirrhosis
|
lipid malabsorption(ADEK)
|
|
Tx in alcoholic liver disease
|
folate 1mg IV/ daily
thiamine 100 mg daily given as IV-rally pack(banna bag) |
|
Portal HTN tx
|
reduce pressure
propranolol 20 mg bid nadolol 40 mg daily (non selective B blockers) |
|
Ascities path flow chart
|
ascities->decrease in arterial blood volume->hyyperdynamic circ.->increase in extracellular fluid
|
|
Ascities 1st line TX
|
Na restriction(<2g/day)
restrict water if hypoNa diuretic therapy-spironolactone with furosemide |
|
2nd line Tx for Ascites
|
paracentesis
plasma expander TIPS-its a shunt(last line) |
|
spironolactone
|
ascites tx
aldosterone antag 100-300 mg PO/day caution in renal |
|
furosemide
|
ascities tx
40-80 mg/day max 160 mg /day |
|
albumin
|
ascities tx
1g/kg/day max 100g/day |
|
tolvaptan use
|
tx hyponatremia secondary to cirrhosis
|
|
tolvaptan contraindic?
dose? |
diminished sense of thirst
15mg daily-Check Na in 8 hours |
|
when do you use tolvaptan
|
Na <125
Na>125 + symptomatic and unresp. to fluid restriction |
|
SBP
|
Spontaneous Bacterial Peritonitis
failure of the immune system diagnosis by PMN >250 or positive bacterial culture |
|
SBP tx
|
paracentesis
C&S of ascitic fluid empiric antibiotics-cefotaxime/ceftriaxone cipro(2nd line) |
|
cefotaxime
dose? |
SBP tx
2g IV q 8 h caution in renal dysfun. |
|
ceftriaxone
|
SBP tx
1g q 24H no adjust. |
|
cipro
|
400 mg IV q 12 H
tendon rupture caution in renal |
|
Varices Tx
|
Acute bleeding?
No(endoscopy)->use BB Yes->Octreotide->still yes generally go to TIPS |
|
Octreotide dose?
|
varices Tx
bolus 100 mcg infusion 25 mcg/hr (18h-5 days) |
|
prophylatic antibiotic choice for varices
|
ceftazidime, ceftriaxone, or fluroquin
serious bleeding->fresh frozen plasma |
|
Somatostatin
|
Varices Tx
growth horomone-inhib. horomone suppresses Vasoactive intestinal peptide(VIP) |
|
Hepatic Enceph. patho
|
abnormal ammonia metab
|
|
HE severity grading
|
stage 0-best
stage 4-worst(coma) |
|
HE tx
|
restrict dietary protein
NPO for 24-48H clearance of ammonia with lactulose, neomycin, rifaximin |
|
flumazenil
|
GABA antag
Not really recc for HE |
|
LACTULOSE
|
HE tx-most used
30-45ml PO q 1-2 H until BM osmotic laxative |
|
Neomycin
|
500mg to 2 g PO q 4-6H
|
|
Metronidazole
|
250mg po BID
disulfuram reaction |
|
rifaximin
|
2nd/3rd gen
400 mg po TID |
|
Liver coag problems
|
effect PT time
thrombocytopenia predisposed to disseminated intravascular coagulation(DIC) |
|
Coag Tx
|
only for active bleeding
give platelet transfusion fresh frozen plasma Vit K(only if Liver is working) |
|
Vit K MOA
|
cofactor for hepatic synthesis
|
|
Hepatorenal syndrome(HRS)
|
kidneys get fucked with no prior evidence its gonna be
-liver fucks up kidneys day job |
|
severe HRS
Extreme HRS |
ascities
hepatorenal syndrome |
|
HRS Tx
|
liver transplant(if not ,death
stop diuretics octreotide midodrine |
|
Fulminant Hepatic Failure
|
onset of HE within 8 weeks
tx-support/transplant |
|
HBV post-exposure prophylaxis
|
requires 2 forms
1-passive immunity of the Hep B immune globuline 2-active immun-HBV vaccination |
|
Definition of chronic HBV
|
Definition of chronic HBV: HBsAg+ for ≥ 6
months |
|
when to tx HBV
|
E antigen(+)->20,000 or >10^5 copies
E antigen(-)->2,000 or >10^4 copies AND elevated ALT >2xNormal or liver disease biopsy |
|
• First line antiviral agents for HBV
|
• First line antiviral agents:
– Peginterferon alfa‐2a (Pegasys®) 180 mcg SQ qweek – Tenofovir (Viread®) 300mg PO daily – Entecavir (Baraclude®) 0.5mg PO daily |
|
second line tx of HBV
|
Lamivudine (Epivir‐HBV®) 100mg PO daily
– Telbivudine (Tyzeka®) 600mg PO daily – Adefovir (Hepsera®) 10mg PO daily |
|
primary goal in HCV
|
– Undetectable HCV RNA, 6 months post‐treatment
(sustained virologic response, SVR) |
|
HCV type 1 tx
|
• Peginterferon alfa‐2a (Pegasys®) 180 mcg SQ qweek
OR • Peginterferon alfa‐2b (Peg‐Intron®) 1.5 mcg/kg SQ qweek AND • Ribavirin 800‐1400 mg/day based on weight, in 2 divided doses • <65kg: Ribavirin 800 mg/day • 65‐85kg: Ribavirin 1,000 mg/day • 86‐105kg: Ribavirin 1,200 mg/day • >105kg: Ribavirin 1,400 mg/day |
|
HCV tx duration
|
tx for 48weeks if RNA is undect. by week 12(Early)
if RNA still detectable at 24 weeks-stop tx extended tx in slow responders |
|
define slow responder
|
≥ 2 log decline in baseline HCV
RNA but HCV RNA positive at week 12, then HCV RNA negative by week 24 |
|
HCV type 2 +3 tx
|
Peginterferon alfa‐2a (Pegasys®) 180 mcg SQ qweek
OR • Peginterferon alfa‐2b (Peg‐Intron®) 1.5 mcg/kg SQ qweek AND • Ribavirin 800 mg/day, in 2 divided doses |
|
Ribavirin
|
synthetic guanosine analog
not for mono therapy type 1 is weight based type 2 is fixed dose |
|
ribavirin AE
|
Anemia, teratogenic(double prevention)
|
|
Ribavirin C/I
|
renal dystfunction, preg, cardiac prob
|
|
Interferon info
C/I |
(a) dose is not weight based
must refrigerate depression, drug abuse |
|
Interferon AE
|
Flu, fatigue, bone marrow suppresion, depression, tx pre-exsiting before starting
|
|
what factors cause nausea in stomach/small intestine area?
|
chemo
surgery radiation |
|
what factors cause nausea in the CTZ?
|
chemo
anesthetics opoids |
|
what factor causes nausea in the labrynth
|
surgery
|
|
what could be used for stomach/small intestine nausea?
|
5-HT3 antag
(thru CTZ) anti-dopinaminergic anti-muscarinic anti-histaminic |
|
what drugs can be used for the CTZ nausea
|
anti-dopinaminergic
anti-muscarinic anti-histaminic cannabinoids |
|
what drugs can be used labyrinths nausea?
|
anti-muscarinic
anti-histaminic |
|
biggest S.E. of phenothiazines
|
dyskinesias
|
