Liver Cirrhosis Treatment and Management

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Questions and Answers

What is the primary goal of administering 50-100 g of highly pure HA to hospitalized cirrhotic patients?

To reduce the dosage of concomitant drugs

To enhance circulatory function and renal function (correct)

To improve hepatic function

To treat contrast-induced nephropathy

What is the maximum daily dose of HA that can be administered to patients who do not respond to the initial dose?

Up to 4 g/kg

Up to 2 g/kg (correct)

Up to 1 g/kg

Up to 3 g/kg

When should the treatment with HA be discontinued?

When the patient's MELD score decreases

When the goal of treatment is achieved (correct)

After a maximum of 7 days of treatment

When the patient's hemoglobin value improves

What is used to assess the response to HA administration?

A daily assessment of clinical, laboratory, and hemodynamic trajectories Signup and view all the answers

Which of the following is NOT a parameter to be evaluated when monitoring response to HA?

Patient's occupation Signup and view all the answers

Why is it important to assess cerebral perfusion pressure when monitoring response to HA?

To evaluate the patient's response to HA in the setting of hepatic trauma Signup and view all the answers

What is the purpose of evaluating microcirculatory blood flow when monitoring response to HA?

To evaluate the patient's response to HA Signup and view all the answers

Why is it important to evaluate dosages of other colloids administration when monitoring response to HA?

To assess the interaction between HA and other colloids Signup and view all the answers

What is the primary purpose of monitoring plasma renin, aldosterone, or antidiuretic hormone concentrations?

Evaluating hypovolemia or hormone-hyponatremia Signup and view all the answers

What is the purpose of assessing the A/G ratio in patients receiving human albumin therapy?

Assessing protein concentrations Signup and view all the answers

What is the significance of monitoring urine output in patients receiving human albumin therapy?

Detecting hypovolemia Signup and view all the answers

What is the purpose of using the Hepatic Encephalopathy Scoring Algorithm (HESA)?

Monitoring hepatic encephalopathy Signup and view all the answers

Why is it important to monitor core or peripheral temperature in patients receiving human albumin therapy?

To monitor vital signs Signup and view all the answers

What is the purpose of assessing hemoglobin levels in patients receiving human albumin therapy?

Determining transfusion needs Signup and view all the answers

Why is it important to monitor central venous pressure in patients receiving human albumin therapy?

To detect hypovolemia Signup and view all the answers

What is the purpose of assessing the AVPU score or the Glasgow Coma Scale (GCS) in patients receiving human albumin therapy?

Evaluating altered consciousness Signup and view all the answers

Why is it important to monitor blood pressure in patients receiving human albumin therapy?

To monitor vital signs Signup and view all the answers

What is the purpose of assessing the grading of signs of hypovolemia in patients receiving human albumin therapy?

Determining the need for rescue therapy Signup and view all the answers

Study Notes

Monitoring and Assessment of Human Albumin Administration

For hospitalized cirrhotic patients, the European Association for the Study of the Liver recommends using 50-100 g of essentially pure HA (≥96% pure) to improve circulatory and renal function, with a maximum daily dose of up to 2 g/kg.
Treatment should be discontinued when the goal is achieved, and continued only if the effect is maintained after follow-up.
Daily assessment of response to HA administration should be based on improvement of:
- Clinical parameters (dyspnea, blood pressure, consciousness, peritoneal signs, and peripheral perfusion)
- Laboratory parameters (hemoglobin value, MELD score, and hepatic function)
- Hemodynamic trajectories

Parameters to Monitor

Laboratory findings to assess:
- Protein concentrations (mass or mole)
- Albumin NC, ONC, and A/G ratio
- Hemoglobin and hematocrit
- Serum creatinine, bilirubin, and pH values
- Plasma renin, aldosterone, or antidiuretic hormone concentrations
- Colloid oncotic pressure (using Sav210 device)
Clinical assessment of organ function and overall condition
Outcomes of principal clinical end-points of the study

Assessment of Efficacy and Safety

Criteria for evaluation of efficacy:
- Hepatic encephalopathy (using Hepatic Encephalopathy Scoring Algorithm)
- Temporal resolution of spontaneous bacterial peritonitis
- Occurrence of compartment syndrome
- Exclusion of acute-on-chronic liver failure after SBP resolution
Criteria for estimation of 'responder' to treatment:
- Resolution of systemic inflammatory response syndrome criteria
- Exclusion of acute-on-chronic liver failure after SBP resolution
Evaluation of safety during treatment should include:
- Vital parameters
- Grading of fluid administration
- Differentiation between colloidal and crystalloid solution
- Grading of criteria for 'rescue therapy'
- Complications (abdominal edema, flushing sensation, and/or hyperpyrexia)
- Estimation of transfusion needs by Hb levels
- Grading of signs of hypovolemia both at clinical and hemodynamic levels

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Description

This quiz assesses your knowledge on the clinical practice recommendations for hospitalized cirrhotic patients, including treatment options and guidelines.