Blog | Thursday, May 10, 2018

Cirrhosis chalk talk

Some days on ward rounds we have time for relatively short chalk talks. Over the years I have developed many. Learners seem to like this one in particular.

We start with this question: name complications that cirrhotic patients develop for which we have secondary prevention. Knowing this list and the associated drugs allows us to peruse the drug list to add to the past medical hsitory when it is not readily available.

Here is my list:

Esophageal varices: most patients with significant varices are taking a non-specific beta blocker. More recently evidence suggests that carvedilol might be better than propranolol or nadolol.

Ascites: not hard to diagnose, often taking spironolactone and furosemide.

Spontaneous bacterial peritonitis: prophylactic antibiotics, recommendations change according to your reference

Encephalopathy: lactulose (many patients hate this) and/or rifaximin

Hepatorenal type 2: midodrine

When one has enough time you stretch out this topics and add more information.

I have left out hepatocellurlar carcinoma, which is not really secondary prevention. One might expand this list for some unusual complications, but this list seems to fit the patients admitted to a community hospital and a VA hospital.

I hope this is helpful.

db is the nickname for Robert M. Centor, MD, MACP. db stands both for Dr. Bob and da boss. He is an academic general internist at the University of Alabama School of Medicine, and the former Regional Dean for the Huntsville Regional Medical Campus of UASOM. He still makes inpatient rounds regularly at the Birmingham VA and Huntsville Hospital. His current titles are Professor-Emeritus and Chair-Emeritus of the ACP Board of Regents. This post originally appeared at his blog, db's Medical Rants.