Disorders of the liver, gb, and ducts

  1. What is the diagnostic criteria for spontaneous bacterial peritonitis?
    The criteria for the diagnosis are an ascitic fluid absolute neutrophil count >250/µL or a positive ascitic fluid culture
  2. What is the treatment of SBP?
    Treatment consists of a third-generation cephalosporin for at least 5 days.
  3. Who should be treated for SBP?
    • Any patient who has had spontaneous bacterial peritonitis should receive antibiotic prophylaxis indefinitely.
    • Any patient who is hospitalized and has a total ascitic fluid protein concentration <1 g/dL should also receive antibiotic prophylaxis, even in the absence of documented spontaneous bacterial peritonitis.
    • Patients with low-protein ascites should receive either daily low-dose or weekly high-dose fluoroquinolones as prophylaxis during hospitalization.
    • Patients with a history of spontaneous bacterial peritonitis should be maintained on this antibiotic long term.
  4. What are the suggestive symptoms of SPB?
    Suggestive symptoms include fever, abdominal tenderness or pain, altered mental status, diarrhea, and paralytic ileus.
  5. What is the intervention to prevent Hepatitis A?
    Prevention of hepatitis A infection consists of judicious use of hepatitis A immune globulin and the hepatitis A vaccine. Immune globulin and the vaccine should be given to all nonimmune contacts within 2 weeks of exposure to an infected person. In addition, persons at high risk and those with chronic liver disease should be vaccinated. The vaccine schedule is two doses separated by 6 to 12 months. There is also a combined hepatitis A/hepatitis B vaccine available.
  6. How is HBV diagnosed?
    HBV DNA assays are commonly used.
  7. What are the treatments for HBV?
    There are six approved therapies for chronic, replicative hepatitis B: interferon (standard and pegylated), lamivudine, adefovir, entecavir, and telbivudine
  8. For a pt with established chronic infection, what do you need to monitor for?
    Patients with established chronic infection must be monitored for the development of cirrhosis and hepatocellular carcinoma. Hepatic ultrasonography and measurement of serum α-fetoprotein every 6 to 12 months are adequate to screen for hepatocellular carcinoma.
  9. An HBV infected woman just delivered. What intervention is needed?
    Infected pregnant women should be given hepatitis B immune globulin immediately after delivery, and the infant should be vaccinated, which can result in a 95% reduction in prenatal transmission.
  10. 1. How do you test for Hep C?
    2. What test would you order for a pt with positive anti-HCV and negative HCV RNA?
    The anti-HCV antibody test is the screening test for at-risk persons; a positive test in a person with one of the risk factors confirms exposure to the virus. The HCV RNA test is required to determine active infection rather than just exposure to the virus. In patients with none of the risk factors who have a positive anti-HCV antibody test and a negative HCV RNA test, the recombinant immunoblot assay (RIBA), which detects antibodies to any of several viral antigens, should be done. A positive RIBA, in the absence of detectable HCV RNA confirms that the patient has been infected with hepatitis C but has spontaneously cleared the infection.
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Disorders of the liver, gb, and ducts