53.3 🩺 內科專科考前版

53.3.0.1 📌 䞀頁重點

  • 22E: HRS-AKI new criteria, terlipressin US-approved, automated LVP
  • Taiwan: cirrhosis HBV/HCV/EtOH 倚

53.3.0.2 💊 進階

53.3.0.2.1 HRS (Hepatorenal Syndrome)
  • HRS-AKI (acute) and HRS-NAKI (non-acute)
  • Terlipressin + albumin (US approved 2022)
  • Norepinephrine + albumin (alt)
  • Liver transplant definitive
53.3.0.2.2 TIPS
  • Indications: refractory ascites, recurrent variceal bleed
  • Contraindications: severe encephalopathy, R heart failure, severe pulmonary HTN
  • Complications: encephalopathy ↑, stenosis
53.3.0.2.3 Liver Transplant
  • MELD-Na score for waitlist priority
  • Cirrhosis + complications (HCC, refractory ascites, recurrent SBP, HRS)
53.3.0.2.4 Antibiotic Prophylaxis
  • Primary: total protein < 1.5 + advanced cirrhosis
  • Secondary: post-SBP
  • Norfloxacin / cipro / TMP-SMX

53.3.0.3 🌟 Pearls (8)

  1. Terlipressin US approved for HRS-AKI
  2. MELD-Na standard for transplant waitlist
  3. Total protein < 1.5 consider primary SBP prophylaxis
  4. TIPS for refractory Child A/B without encephalopathy
  5. Automated LVP systems reducing complications
  6. Cardiac vs cirrhotic ascites: both SAAG ≥ 1.1, total protein 區分
  7. Pancreatic ascites: high amylase
  8. Chylous ascites: triglyceride > 200, lymphatic obstruction

53.3.0.4 📍 Taiwan Context

  • HBV / HCV cirrhosis 倚
  • HCC 高
  • 健保 transplant
  • Terlipressin 自費 (US approved 2022)
  • 健保 albumin

53.3.0.5 🎓 內專重點

  1. SAAG categories
  2. SBP + albumin
  3. HRS + terlipressin
  4. TIPS / transplant
  5. Cardiac vs cirrhotic
  6. Cancer / TB / nephrotic / pancreatic ascites

⚠ AI 草皿。