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MEDSURG | Liver & Biliary

STAT Stitch Deep Dive Podcast Beyond The Bedside Β· Regular Guy

November 12, 202534m 40s

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Show Notes

🟠 Cirrhosis

Patho: Hepatocyte loss β†’ fibrotic nodules β†’ portal HTN β†’ varices/ascites; ↓ albumin & clotting factors; ↑ ammonia β†’ hepatic encephalopathy (HE).

Meds: β€’ Diuretics: spironolactone (K⁺-sparing), furosemide (K⁺-wasting) β†’ track I&O, K⁺. β€’ Ammonia ↓: lactulose (2–3 soft stools/day), rifaximin (↓ gut bacteria). β€’ Varices: non-selective Ξ²-blockers (propranolol/nadolol) prevent bleed; octreotide acutely; vasopressin rescue. β€’ Coags: vit K if PT/INR prolonged.

Watch for:

  1. Variceal bleed (hematemesis/melena β†’ shock).
  2. HE grade 3–4 (confusionβ†’coma).
  3. Coagulopathy (bruising, epistaxis).
  4. Ascites/edema (SBP risk).
  5. Jaundice, spider angiomas, palmar erythema.

RN priorities: β€’ HE: q2h neuro, asterixis, NH₃; give lactulose/rifaximin; remove GI blood; bowel regimen. β€’ Ascites: daily weight, I&O, girth marks, skin checks; Na restriction; diuretics; semi-Fowler’s; void pre-paracentesis. β€’ Varices: vitals, PT/INR, platelets; no ETOH/NSAIDs/aspirin; Ξ²-blocker adherence. Active bleed β†’ 2 large-bore IVs, type & cross, octreotide; balloon tamponade safety (label/secure; scissors at bedside). Pearls: Prolonged PT/INR, low albumin signal decline; fetor hepaticus = HE.

πŸ”΄ Acute Pancreatitis

Patho: Premature enzyme activation β†’ autodigestion, necrosis/hemorrhage β†’ massive third-spacing β†’ hypovolemia/shock; fat necrosis β†’ hypocalcemia.

Meds: IV opioids (morphine/dilaudid), dicyclomine, PPIs/H2, antacids.

Red flags:

  1. Shock (hypotension/tachy).
  2. Resp: effusions/atelectasis β†’ ARDS.
  3. Severe LUQ/epigastric pain β†’ to back, not relieved by emesis.
  4. Hemorrhage signs: Cullen (umbilicus), Grey-Turner (flanks).
  5. Hypocalcemia (Chvostek/Trousseau)

🟑 Viral Hepatitis (A–E)

Patho: Viral hepatocyte injury β†’ inflammation/necrosis; ↓ bilirubin processing β†’ jaundice; chronic HBV/HCV β†’ fibrosis β†’ cirrhosis/HCC.

Tx: β€’ Acute: supportive only (rest, nutrition; antihistamines for pruritus). β€’ Chronic HCV: DAAs (e.g., sofosbuvir/velpatasvir) β†’ >95% cure. β€’ Chronic HBV: tenofovir/entecavir long-term; peg-IFN (flu-like sx, depression). β€’ Diet: well-balanced, small frequent meals; no alcohol.

Phases/Signs: β€’ Acute/icteric: jaundice, malaise, low-grade fever, RUQ pain, anorexia; early smell aversion/food repugnance. β€’ Convalescent: prolonged fatigue (wks–mos). β€’ Fulminant failure: encephalopathy + coagulopathy β†’ ICU.

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