What is the MELD used for?
rank liver transplant candidates
What are the criteria for liver transplant? -3
- 6 months sober
- Attend rehab
- Adequate supports
What is a sign of decompensated liver disease?
Ascites (stage 3/4)
What medications are recommended for pain management in liver disease? -2
- Mild: Tylenol
- Moderate: Fentanyl
What treatments are available for pruritis in liver disease?-4
- Cholestyramine (1st line)
- Rifampicin
- Naltrexone
- SSRI
What is the prophylaxis for spontaneous bacterial peritonitis (SBP)? -2
- Septra
- Cipro
What is the treatment for acute bacterial infection in liver disease? -3
- IV cefotaxime or ceftriaxone
- Aggressive fluid resuscitation
- IV albumin
What are the symptoms of hepatic encephalopathy (HE)? -4
- Asterixis (flapping tremor)
- Fetor hepaticus (sweet, musty breath)
- ↑ ammonia level
- Worsening neuro (inattention - lethargy- somnolence -coma)
What medications are used to treat hepatic encephalopathy (HE)? -3
- Lactulose (1st line)
- Rifaximin
- Ciprofloxacin
What is the treatment for esophageal varices? -2
- Octreotide
- Endoscopic band ligation
What medications are used for ascites management?-2
- Spironolactone
- Furosemide
What is the treatment for refractory ascites?
- Serial large volume paracentesis (LVP)
- TIPS (if no heart failure)
What is the management for hepato-renal syndrome? -2
- Stop diuretics and Beta-blockers
- Give vasoconstrictor (norepinephrine, albumin)
why have Surrogate/ACP early (ESLD)
risk of encephalopathy
assessments for ESLD -3
Child-Pugh classification, NRS, ESAS-r,
what meds are not used for pain management and why (ESLD)- 3
(no morphine, codeine, nsaids)- risk of HE, CNS depression, OIC
complications of ESLD (5)
spontaneous bacterial peritonitis
hepatic encephalopathy
esophageal varices
ascites
hepato-renal syndrome
