HE

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Author:
alvo2234
ID:
269697
Filename:
HE
Updated:
2014-04-07 23:44:35
Tags:
PT
Folders:
exam 3
Description:
zagaar
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  1. tests for hepatocellular injury
    • aminotransferases
    • lactate dehydrogenase
  2. which LDH enzyme is the most useful
    isoenzyme LDH5, its fairly specific for the liver
  3. tests for cholestatic disease and which one is best used as a marker
    • alkaline phosphatase (ALP)
    • y-glutamyl transpeptidase (GGTP)
  4. tests for metabolic capacity
    • bilirubin;
    • indirect (unconjugated)-increased hemolysis
    • direct (conjugated)
  5. history and physical findings of HE
    • ascites
    • splenomegaly
    • hepatomegaly
    • spider angiomata
  6. precipitating factors of HE
    • GI bleeding
    • excess dietary protein
    • constipation
    • azotemia
    • electrolyte disturbances
    • shunts
    • cns depressants
  7. what is covert encephalopathy
    minimal hepatic encephalopathy
  8. what is the subclinical presentation of MHE
    normal clinical exam but abnormal psychometric tests

    diminish a pt capacity to execute daily function
  9. what are the different types of overt HE
    episodic recurrent- 2 spontaneous episodes that occur in 1 yr

    episodic persistent- symptomatic all the time despite tx
  10. west haven criteria 0
    normal
  11. west haven criteria 1
    • hypersomnia/insomnia
    • inversion of sleep pattern
    • mild confusion
  12. west haven criteria stage 2
    • lethargy or apathy
    • time disorientation
    • obvious asterixis
    • gross inability to perform mental tasks
  13. west haven criteria stage 3
    • marked confusion
    • gross disorientation
    • abnormal reflexes
  14. west haven criteria stage 4
    • coma
    • babinski sign present
  15. clinical physical exam findings
    • fetor hepaticus
    • asterixis
  16. mental status changes
    • serial 7
    • subtracting A
    • dots, stars
  17. neurologic abnormalities
    • focal (deep tendon, babinski)
    • ataxia, dysarthria, tremor
  18. antibiotics used to treat HE
    • neomycin
    • flagyl
    • rifaximin
  19. dosing for neomycin
    1g QID x 1 wk
  20. dosing for metronidazole
    250 mg 2-3 x daily
  21. dosing for rifaximin
    400 mg TID 5-10 days
  22. SE of neomycin
    • nephro
    • ototox
    • n/v
    • malabsorption and ab pain
  23. monitoring for flagyl
    metallic taste and peripheral neuropathy
  24. rifaximin tx what stages of HE
    1-3
  25. rifaximin has what coverage
    gram-negative rods and gram-positive cocci
  26. dosing of rifaximin for overt HE recurrence
    550 mg BID
  27. dosing of flumazenil
    1 mg IV bolus in refractory pts if BZD intake suspected
  28. dosing for zinc
    220 mg qd
  29. how does zinc deficiency affect nitrogen metabolism
    impairs the activity of urea cycle enzymes and glutamine synthetase
  30. when are probiotics used and not used in HE
    used in MHE and not an option for serious HE
  31. what is the dietary protein restriction and when and how should the food be given
    • 1-1.5 g/kg per day after HE symptoms resolveĀ 
    • vegetable and dairy sources preferred to meat
    • use in combo with bowel cleansing agents
  32. how can < 40 g per day affect nutrition
    can accelerate muscle catabolism and contribute to malnutrition
  33. dosing for lactulose
    • oral suspension; 15-45ml TID-QID (2-3 stools)
    • enema; 300ml lactulose/700ml-1L pr for 30-60 min
  34. when is lactulose used
    in acute and chronic HE
  35. which agents are used as prophylaxis until transplants
    • rifaximin
    • lactulose

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