PAC3421 Study Guide - Final Guide: Spontaneous Bacterial Peritonitis, Esophageal Varices, Portal Hypertension

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Department
Course
Professor
Advanced Liver Disease
1. Itching – due to deposition of bile salt in the skin
Which of the following is not used in the management of itching?
A. Rifampicin
B. Norfloxacin
C. Ursodeoxycholic acid
D. Bile acid binding resins
E. None of the above
2. Ascites and portal hypertension
What are the reasons of development of ascites? Describe the treatment for each of the reasons.
A. Portal hypertension – causes back pressure in portal vein and nearby capillaries, and hence subsequent
leaking
a. can be managed by propranolol
B. Albumin main protein involved in creating an osmotic gradient to hold water intravascularly Albumin
synthesis is decreased in liver impairment,
a. can be managed by administering IV albumin from blood bank
C. Activation of RAAS (because body is dehydrated) and build-up of aldosterone (because aldosterone is
usually removed by liver metabolism) and accumulated aldosterone results in fluid retention,
a. can be managed by using spironolactone alone (in mild ascites)
b. Switch spironolactone to amiloride if experienced gynaecomastia
c. Spironolactone + loop diuretics in combo in moderate-to-severe ascites; but have to ensure
appropriate fluid balance to avoid dehydration due to side effects of drugs
3. Spontaneous bacterial peritonitis due to dilution of immune factors such as complement system in the
peritoneal space
-Prophylaxis: oral norfloxacin (antibiotic)
-Treatment: ceftriaxone
4. Hepatorenal syndrome multifactorial which is usually related to decreased kidney flow, sepsis from
SBP, volume depletion and bleeding
-Development of ACUTE kidney injury on top of advanced liver disease (both organs shut down)
-Treatment: Terlipressin + Albumin
5. Esophageal varices and bleeding
-Prophylaxis (prevent bleeding): Propranolol (for managing portal hypertension because portal
hypertension causes blood to be diverted into oesophageal veins)
-Treatment (active bleeding): Terlipressin + Octreotide (for decreasing blood flow in the area) + PPI (for
ulceration)
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Document Summary

Itching due to deposition of bile salt in the skin. Which of the following is not used in the management of itching: rifampicin, norfloxacin, ursodeoxycholic acid, bile acid binding resins, none of the above. Spontaneous bacterial peritonitis due to dilution of immune factors such as complement system in the peritoneal space. Hepatorenal syndrome multifactorial which is usually related to decreased kidney flow, sepsis from. Development of acute kidney injury on top of advanced liver disease (both organs shut down) Prophylaxis (prevent bleeding): propranolol (for managing portal hypertension because portal hypertension causes blood to be diverted into oesophageal veins) Treatment (active bleeding): terlipressin + octreotide (for decreasing blood flow in the area) + ppi (for ulceration) Treatment: lactulose alone, given until bowels are quite regular and loose: lactulose makes ammonia insoluble to prevent its absorption from gut into blood and brain.