Bcacp - Gi Disorders Exam Questions And Answers 2024

CTP class A points 5-6 points CTP class B points 7-9 points CTP class C points 10-15 points CTP encephalopathy points 1 = absent 2 = medically controlled 3 = poorly controlled CTP ascites points 1 = absent 2 = diuretic response 3 = diuretic refractory CTP bilirubin points 1 = 2 2 = 2-3 3 = 3 CTP albumin points 1 = 3.5 2 = 2.8-3.5 3 = 2.8 CTP INR points 1 = 1.7 2 = 1.7-2.3 3 = 2.3 first line therapy for ascites sodium restriction to 2000 mg/day + spironolactone and furosemide at ratio of 100 mg to 40 mg alternative to spironolactone in ascites amiloride when to initiate primary prophylaxis for SBP cirrhosis + ascites + low ascitic protein concentration (1.5) + one of the following: SCr of 1.2 or greater, BUN of 25 or greater, Na of 130 or less, CTP score of 9 or more + bilirubin of 3 or greater when to initiate secondary prophylaxis for SBP in any patient with hx of SBP medications used for SBP treatment cipro 500 mg/day, TMP/SMX DS daily, rifaximin 400 mg TID, or rifaximin 550 mg BID indication for liver transplant recurrent intractable HE + liver failure monitoring efficacy of HE treatment symptoms, not ammonia levels first line therapy for HE lactulose 45 mL titrated to 2-3 soft stools per day add on therapy for HE rifaximin 550 mg BID alternative therapy for HE and what limits their use neomycin (limited by nephro and ototoxicity) and metronidazole (limited by neurotoxicity) nutritional management in HE daily energy intake 35-40 kcal/kg protein intake 1.2-1.5 g/kg/day lactulose MOA lactulose is degraded by colonic bacteria to acid, lowering gut pH and converting ammonia to ammonium in the GI lumen lactulose ADRs flatulence, diarrhea, abdominal cramping, unpleasant taste indication for prophylaxis of gastroesophogeal varices medium to large varices or any hx of variceal bleeding medication for gastroesophogeal varices nonselective beta blockers (propranolol or nadolol) beta blocker targets in varices HR 55-60 bpm nonselective beta blocker precautions bronchospastic disease, PVD, Raynaud, DM therapies to avoid in gastroesophageal varices long acting nitrates when to recommend postexposure prophylaxis for HAV with immune globulin 12 months, 40 years, = 12 months + immunocompromised, if vaccine is contraidicated hepatitis B surface antigen HBsAg - indicates infection hepatitis B surface antibody HBsAB/anti-HBs - indicates protective immunity hepatitis B core antibody anti-HBc - indicates previous or ongoing infection hepatitis B early antigen HBeAg - indicates ongoing viral replication hepatitis B early antibody anti-HBe - appears temporarily during acute infection or consistently after burst of viral replication IgM antibody to hepatitis B core antigen IgM anti-HBc - indicates acute (recent infection within past 6 months phases of chronic HBV immune-tolerant phase, immune-active phase, inactive "carrier" phase monitoring after discontinuation of HBV treatment every 3 months for at least 1 year; HCC surveillance should continue indication for treatment of HBV in compensated cirrhosis all patients with low levels of viremia (2000) regardless of ALT concentration preferred treatment for HBV in compensated cirrhosis tenofovir or entacavir preferred treatment for HBV in decompensated cirrhosis and duration entecavir or tenofovir disoproxil indefinitely pegylated interferon dosing in HBV 180 mcg SC weekly for 48 weeks factors associated with favorable response to treatment in patients with HBeAg-positive disease high pretreatment ALT, low HBV DNA concentration, HBV genotypes A and B, active inflammation on liver biopsy monitoring for pegylated IFN CBC q4weeks, TSH and HBV DNA q12weeks, HBeAg and anti-HBe q24weeks pegylated IFN ADRs transient elevation in LFTs, bone marrow suppression, psychosis, thyroid abnormalities, neuropathy black box warning for nucleoside analogs lactic acidosis monitoring for nucleoside analogs in HBV hepatic panel q12weeks, SCr q12weeks (in tenofovir), HBV DNA q12-24weeks, HBeAg and anti-HBe q24weeks