Hepatitis C Patients with Cirrhosis in Primary Care Clinics: Implementing Evidence-Based Guidelines Poster Presentation Handout for Scholarly Event March 26, 2013 Michelle M. Lisowski NURS 770: Clinical Scholarship IV Winona State University
Educational Items Distributed to Primary Care Providers 1. Clinicians Guide The full text or pdf of this document can be found and downloaded at www.hepatitis.va.gov. This document is not copyrighted and users are encouraged to print and distribute as many copies as they need.
2. Laminated Pocket Card Cirrhosis Treatment Recommendations HCC surveillance (every 6 months): Ultrasound AFP No varices Part of the Cirrhosis Quicknotes which constitute an abbreviated version of the Management and Treatment of Patients with Cirrhosis and Portal Hypertension (2009), developed by the Department of Veterans Affairs Hepatitis C Resource Center Program. Repeat endoscopy in 3 years (sooner if decompensation occurs) Management of compensated cirrhosis (no ascites, variceal hemorrhage, encephalopathy, or jaundice) Varices surveillance (upper endoscopy) Small varices In a CTP class B or C patient or varices with red signs In a CTP class A patient, without red signs Nonselective betablockers (propranolol or nadolol) Nonselective beta-blockers optional Start propranolol (20 mg BID) or nadolol (40 mg QD) Titrate to maximum tolerable dosage or a heart rate of 55-60 beats/min No need to repeat endoscopy If no beta-blockers given, repeat endoscopy in 2 years (sooner if decompensation occurs) Medium/Large varices prevention of first variceal hemorrhage Nonselective beta-blockers (propranolol, nadolol) OR Endoscopic variceal ligation (choice depends on patient characteristics and preferences, local resources) Start propranolol (20 mg BID) or nadolol (40 mg QD) Titrate to maximum tolerable dosage or a heart rate of 55-60 beats/min No need to repeat endoscopy Ligate every 1-2 weeks until variceal obliteration First surveillance endoscopy 1-3 months after obliteration, then every 6-12 months indefinitely
3. Hepatocellular Carcinoma Pocket Card from GuidelineCentral.com (Pocket card is copyrighted not able to past to this document) Article on diagnosing cirrhosis sent to providers 1-2 weeks post educational seminar: Udell, J. A., Wang, C. S., Tinmouth, J., FitzGerald, J. M., Ayas, N. T., Simel, D. L.,... Yoshida, E. M. (2012). Does this patient with liver disease have cirrhosis? The Journal of the American Medical Association, 307(8), 832-842.
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