Sodium restriction alone with diuretic is the initial

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SODIUM RESTRICTION ALONE WITH DIURETIC IS THE INITIAL TREATMENT. 123
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THE INITIAL TREATMENT OF CIRRHOTIC ASCITES IS RESTRICTION OF SODIUM SODIUM SHOULD BE RESTRICTED TO 88 MEQ (2000 MG/DAY) . DIURETIC THERAPY TYPICALLY CONSISTS OF TREATMENT WITH SPIRONOLACTONE AND FUROSEMIDE IN A RATIO OF 100 : 40 MG/ DAY 124
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125
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TREATMENT : 1. DISCONTINUE ALCOHOL 2. DISCONTINUE MEDICATIONS THAT DECREASE RENAL PERFUSION (I.E., NSAIDS, BETA-BLOCKERS, ACES, ARBS) 3. TREAT UNDERLYING LIVER DISEASE WHEN POSSIBLE 4. DIETARY EDUCATION 2G (88 MMOL) PER DAY SODIUM- RESTRICTED DIET 126
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5. DIURETICS: - SPIRONOLACTONE 100 MG PER DAY PLUS ORAL FUROSEMIDE 40 MG PER DAY GIVEN IN THE MORNING AS A SINGLE DAILY DOSE - TITRATE DOSES UPWARD AS NEEDED AT INTERVALS OF > 3 TO 5 DAYS. - WHEN TITRATING DOSES, MAINTAIN A RATIO OF 100 MG SPIRONOLACTONE TO 40 MG FUROSEMIDE - USUAL MAXIMUM DAILY DOSES: 400 MG SPIRONONOLACTONE AND 160 MG ORAL FUROSEMIDE - IN SMALL PATIENTS WITH A SMALL VOLUME OF ASCITES, START WITH LOWER DOSES (E.G., SPIRONOLACTONE 50 MG PER DAY PLUS ORAL FUROSEMIDE 20 MG PER DAY). 127
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Q- CIRRHOSIS TREATMENT USE OF SPIRONOLACTONE IN LIVER CIRRHOSIS IS - A) DECREASE EDEMA (NBE BASED AI 13 PATTERN) B) IMPROVES LIVER FUNCTION C) DECREASE AFTERLOAD D) DECREASE INTRAVASCULAR VOLUME A 128
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FIRST LINE OF TREATMENT IN SEVERE ASCITES - A) BED REST AND SALT RESTRICTION (PGI JUNE 98) B) HEAVY PERACENTESIS C) SHUNT D) LARGE DOSE OF DIURETICS 129
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130
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PARACENTESIS: THIS HAS MULTIPLE ROLES. - FOR DIAGNOSIS (NEW ONSET ASCITES, SUSPICION OF MALIGNANT ASCITES OR SPONTANEOUS BACTERIAL PERITONITIS). THERAPEUTIC MANOEUVER (WHEN TENSE ASCITES CAUSES SIGNIFICANT DISCOMFORT OR RESPIRATORY COMPROMISE). 131
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FIRST LINE OF TREATMENT IN SEVERE ASCITES - A) BED REST AND SALT RESTRICTION (PGI JUNE 98) B) HEAVY PARACENTESIS C) SHUNT D) LARGE DOSE OF DIURETICS B 132
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Q- HEPATIC FAILURE FEATURE OF ACUTE FULMINANT HEPATIC FAILURE INCLUDES- A) HYPERGLYCEMIA (PGI JUNE 01) B) HEPATORENAL SYNDROME C) HYPERMAGNESEMIA D) MOSTLY DRUG INDUCED E) FETOR HEPATICUS 133
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134
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135
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Q- HEPATIC FAILURE FEATURE OF ACUTE FULMINANT HEPATIC FAILURE INCLUDES- A) HYPERGLYCEMIA (PGIJUNE 01) B) HEPATORENAL SYNDROME C) HYPERMAGNESEMIA D) MOSTLY DRUG INDUCED E) FETOR HEPATICUS B,D,E. 136
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MELD 137
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THE MODEL FOR END-STAGE LIVER DISESE (MELD) IS A PROSPECTIVELY DEVELOPED AND VALIDATED CHRONIC LIVER DISEASE SEVERITY SCORING SYSTEM THAT USES A PATIENT’S LABORATORY VALUES FOR – - SERUM BILIRUBIN - SERUM CREATININE - THE INTERNATIONAL NORMALIZED RATIO (INR) FOR PROTHROMBIN TIME TO PREDICT THREE MONTH SURVIVAL. 138
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PATIENTS WITH CIRRHOSIS, AND INCREASING MELD SCORE IS ASSOCIATED WITH INCREASING SEVERITY OF HEPATIC DYSFUNCTION AND INCREASED THREE-MONTH MORTALITY RISK.
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  • Winter '16
  • jean grey
  • chronic hepatitis, chronic liver failure

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