Cirrhosis is the final stage of liver disease.
■ Starts with deposits of fat, progresses to fibrosis, then continues on to
○ Presents with jaundice, pruritus, palmar erythema, and spider angiomata.
○ Complications include ascites, spontaneous bacterial peritonitis, portal hypertension, esophageal varicea, hepatic encephalopathy, and coagulation disorders.
■ Leads to increased hospital admission.
Alcoholism is the most common cause of liver cirrhosis, followed by HepC, then nonalcoholic fatty liver disease
■ Gallstones are the main cause of acute pancreatitis. ● In women, remember the four F's fat, forty, female, fertile.
■ Second is alcohol consumption ■ Drugs
● 2345: didanosine, theophylline, tetracycline, pentamidine, Lasix.
● PADS: pentamidine, azathioprine, didanosine, sulfas.
● ACEi, Thiazides, H2
■ You may see combination therapies, but you should only see one drug from each class.
■ Start with β blockers/topical prostaglandin analogues, then alpha agonists, then cholinergic agonists/oral therapies.
● MOA: decreases aqueous humor production.
● Cardio selective (betaxolol) ● Non cardioselective (timolol, levobunolol, metipranolol, carteolol)
● Advantages ○ Highly effective, fewer side effects, don't affect pupil size or color.
● Disadvantages ○ Respiratory, CNS, and cardiac effects from NSBBs. Very rare
Vascular, neurological, or hormonal etiology
■ HTN, peripheral vascular disease, stroke, spinal cord injury, diabetes, hypogonadism. ○ Psychogenic
■ Malaise, depression, Alzheimer's disease, psychiatric disorders, performance disorder.
■ Respond better to ED treatment (maybe placebo?)
○ Disease states ■ Dementia/delirium, depression, UTIs, atrophic urethritis or vaginitis, DM, neurological diseases, pelvic malignancies, constipation
○ Behavioral causes
■ Remember DIAPPERS ■ Delirium, infection, atrophic vaginitis, psychiatric disorders, pharmacological treatments, excessive urine output, restricted mobility, stool impaction
■ Diuretics, CCBs, ACEi (cough), narcotic analgesics, sedatives, anticholinergics, TCAs, alcohol.