Ascites

Question 1

decreased _____ can lead to ascites

Answer 1

Oncotic pressure

Question 2

What can lead to a fluid shift from intra to extra vascular?

Answer 2

Low albumin

Question 3

When the kidneys sense hypoperfusion, what is increased? 2

Answer 3

1. Renin
2. Aldosterone

Question 4

To prevent ascites, what needs to be managed?

Answer 4

Portal hypertension

Question 5

What nutrition requirements would help prevent ascites?

Answer 5

1. Maintain protein intake
2. Mild salt restriction

Question 6

What is the weight loss goal through diuresis?

Answer 6

0.5 kg daily

Question 7

What is the Spironolactone: Furosemide ratio?

Answer 7

100:40

Question 8

What is the target dose for Spironolactone in ascites?

Answer 8

400 mg

Question 9

What is the target dose for furosemide in ascites?

Answer 9

160 mg

Question 10

Spironolactone can cause ____kalemia

Answer 10

Hyper

Question 11

Furosemide can cause _____kalemia

Answer 11

Hypo

Question 12

What drug should you consider for refractory ascites?

Answer 12

Midodrine

Question 13

What needs replaced in refractory ascites?

Answer 13

Albumin

Question 14

What surgery can a patient receive for refractory ascites?

Answer 14

Trans jugular intrahepatic portosystemic shunt (TIPS)

Question 15

What is the MOA of midodrine?

Answer 15

Alpha 1 agonist

Question 16

What does midodrine help maintain for the diuretics to be increased?

Answer 16

Blood pressure

Question 17

What are 4 ADRs for midodrine?

Answer 17

1. Urinary retention
2. Itching
3. Hypertension
4. Paresthesia

Question 18

Drainage of the fluid is called

Answer 18

Paracentesis

Question 19

What can lead to hepatorenal syndrome?

Answer 19

Hypotension

Question 20

What needs to be utilized to avoid a ascitic leak?

Answer 20

Z track technique

Question 21

What are 3 complications of paracentesis?

Answer 21

1. Bleeding
2. Ascitic fluid leak
3. Infection

Question 22

When is albumin replacement recommended?

Answer 22

When >5 L of fluid is removed

Question 23

What preparation of albumin is used?

Answer 23

25%

Question 24

What is the dose for albumin replacement?

Answer 24

8g/L

Question 25

Renal failure due to hypoperfusion of the kidneys

Answer 25

Hepatorenal syndrome

Question 26

What 2 drug classes **MUST** be avoided in hepatorenal failure?

Answer 26

1. NSAIDs 2. Aminoglycosides

Question 27

What type of hepatorenal failure?: slow progressive renal failure

Answer 27

Type 2

Question 28

What type of hepatorenal failure?: acute renal failure

Answer 28

Type 1

Question 29

What type of hepatorenal failure?: May respond to therapy and improve to baseline renal function

Answer 29

Type 1

Question 30

What type of hepatorenal failure?: no effective treatment can stop progression

Answer 30

Type 2

Question 31

What type of hepatorenal failure?: Has better prognosis

Answer 31

Type 1

Question 32

What are 3 symptoms of spontaneous bacterial peritonitis?

Answer 32

1. Fever 2. Abdominal pain 3. Mental status changes

Question 33

What is the translocation of intestinal bacteria into the peritoneum due to?

Answer 33

Decreased bowel motility, increased bacterial growth, increased intestinal permeability

Question 34

What is the main thing needed for primary prophylaxis of bacterial peritonitis?

Answer 34

Low ascitic fluid protein (<1.5 g/L)

Question 35

What 4 additional things are needed for primary prophylaxis in spontaneous bacterial peritonitis?

Answer 35

1. Impaired renal function (SCr >1.2) 2. BUN >25 3. Sodium <130 mEq 4. Liver failure (Child’s Pugh >9 and bilirubin >3 mg/dL)

Question 36

What patients need secondary prophylaxis for spontaneous bacterial peritonitis?

Answer 36

**ALL** patients with SPB diagnosis and liver disease

Question 37

What are 2 prophylactic agents needed for SBP?

Answer 37

1. Ciprofloxacin 2. Bactrim (quinolone intolerance)

Question 38

What is the PMN count that is needed for diagnosis of SBP?

Answer 38

>250 mm3

Question 39

What needs to be assessed for SBP?

Answer 39

If community or hospital-acquired

Question 40

What is the criteria for monitoring if the bacteria community or hospital acquired?

Answer 40

1. >48 hours in the hospital on current admission or within 3 months 2. Recent utilization of IV antibiotics (90 days)

Question 41

If the SBP is community acquired what is used for treatment?

Answer 41

1. Cefotaxime 2. Ceftriaxone (Use quinolones if allergy)

Question 42

If the bacteria is nosocomial what is used to treat?

Answer 42

1. Zosyn 2. Cefipime 3. Carbapenems (If MRSA positive add vancomycin)

Question 43

How long are IV antibiotic used?

Answer 43

5 days

Question 44

If HVPG is reduced by ___% or more ascites improves or is prevented

Answer 44

10