Kaminski GI Final

Most common causes of Acute Pancreatitis?

1. Gallstones

2. Alcohol

Hallmark Symptom of Acute Pancreatitis?

abdominal pain

Elevated lab tests in Acute Pancreatitis?

Amylase and LIpase 3x ULN

Diagnosis of Acute Pancreatitis?

Requires two of three criteria: upper abdominal pain, serum lipase or amylase 3X

ULN, or characteristic findings on imaging

Lipase more sensitive and preferred

Treatment of Acute Pancreatitis?

Enteral Nutrition

Most common cause of Chronic Pancreatitis?

Alcohol

Nonpharm treatment of Chronic Pancreatitis?

Quit Alcohol and smoking
Patients with steatorrhea – smaller, more frequent meals; reduce dietary fat intake

Pharm Treatment of Chronic Pancreatitis?

Pancreatic enzyme replacement therapy (PERT)
Supplementation of fat-soluble vitamins if necessary

T/F all PERT products are equivalent

F

PERT names

Viokace

Pertzye

Creon

Pancreaze

Zenpep

1 HR done

nlgEr

Drug Induced Liver Damage Causes (DILI)

Acetimnophen
Herbals
Alcohol

DILI Risk factors

Pre existing Liver Disease
>2 alcholic beverages per day
alcohol binge more then once per month
>60 yrs old
pregnancy
type 2 DM
herbal supplements

What can we use to asses the likelihood of a drug causing DILI?

RUCAM

3 catagories of DILI

Hepatocellular damage
Cholestatic damage
Mixed hepatocellular cholestatic damage

Lab values for Hepatocellular damage

Markedly high AST and ALT

Lab value for Cholestatic damage

Markedly high Alk Phos (3x ULN)

R factor score for each DILI category

Cholestatic R factor is < 2,
Mixed R factor is between 2 and 5.
Hepatocellular R factor is > 5,

Centrilobular Necrosis cause

Acetaminophen

How do we treat Acetaminophen toxicity and what is the dosed based on?

N-acetylcysteine

dosed based on Rumack-Matthew Nomogram

NASH/MASH cause

Tetracycline
Valproate

Phospholipidosis cause

Amiodarone

2 hrs done

Common Causes of Cirrhosis

Chronic Hepatitis C
Alcohol
NAFLD/MASLD

Explain the pathophysiology of liver cirrhosis.

Fibrosis of the liver → portal hypertension → gastroesophageal varices and bleeding

Sytemic Vasodilation → RAAS activation → Na⁺ and water retention → ascites.

Cirrhosis lab values

increased LFTs, elevated bilirubin, low albumin, elevated INR

Compensated Cirrhosis

Asymptomatic, no major complications, may have varices with NO BLEEDING

Decompensated Cirrhosis

Has complications, bleeding varices, ascites, encephalopathy.

TEST QUESTION
Which patient has compensated cirrhosis?

3 options with pts having compilcations
1 with nothing - right answer

What is Child Pugh and MELD score used for?

Child Pugh - drug dosing adjustments

MELD - transplant list

Primary Prophylaxis treatment of Varices

non selective beta blockers (Propranolol, Nadolol, Carvedilol)

endoscopic variceal ligation (EVL) - non pharm

Which of the non selective BB has alpha blocking activity as well?

Carvedilol

When can we use EVL in prophylaxis?

C/I or cant tolerate BB
medium to large varices

Treatment of Acute Variceal Bleeding

Octreotide (Sandostatin) and EVL

Secondary Prophylaxis Treatment (after bleeding episode)

non selective BB and EVL

What else is started after Variceal bleeding?

SBP prophylaxis - Ceftriaxone x7 days

What do you perform when new onset Ascites is found?

paracentesis should be performed and ascitic fluid should be analyzed

Diuretic use for Ascites

spironolactone 100 mg and furosemide 40 mg
100:40 ratio

When are empiric antibiotics started in SBP?

PMN count >250

Treatment after SBP episode?

ALL patients who have survived an episode of SBP should receive ciprofloxacin 500 mg daily

Hepatic Encephalopathy is characterized by what?

Ammonia

Hyperammonia treatment

Lactulose
Rifaximin (Xifaxan)

How is Lactulose Titrated?

until 2-3 soft stools per day

What 2 drugs can be used in MASH F2-F3 only?

Resmetirom and Semaglutide

Stopped at slide 55 nothing after is in study guide, Liver tox next

1. What is a likelihood score?

indicates how likely a drug is to cause drug-induced liver injury (DILI)

2. Interpret the likelihood score

answer might be x

3. Limitation of likelihood score?

Limited or insufficient evidence may make the likelihood score unreliable

the newer the less accurate

4. Valproate MOA and what type of liver tox does it cause?

increases GABA levels, by inhibiting its breakdown, and blocks voltage-gated sodium and T-type calcium channels to reduce neuronal excitability

Hepatocellular w jaundice, reyes, and hyperammonia

5. Valproate Antidote

L-carnitine (levocarnitine)

6. Lab Values for cholestatic and hepatocellular

hepatocellular high AST + ALT
cholestatic high Alk Phos

7. Be able to calculate dose if given weight and dose

i have no idea what the context of this is

8. Can a patient receive Augmentin again after experiencing liver injury

No

9. How do you adjust lamotrigine in hepatic impairment?

Child-Pugh B without ascites: 25% reduction - most likely - 225 mg

Child-Pugh B with ascites or Child-Pugh C: 50% reduction

10. Read Rumack Mathew nomogram and decide wether pt should be treated

will put the answer when i figure it out

js gna assume ya

11. If 30mL vials of Acetadote 20% are used to draw up the doses calculated above,

how many will be required to compound each dose?

9270

12. What is the mechinism of acetiminophen toxicity?

NAPQI

13. Calc R score

8.75