25: Chronic Liver Dz And Cirrhosis

Question 1

Major complication associated with Hep B vs Hep C

Answer 1

Hep B: polyarteritis nodosa

Hep C: mixed cryoglobulinemia

Question 2

Major lab + imaging to ID fibrosis due to cirrhosis

Answer 2

1. Serum fibrosure lab

2. US elastography

Question 3

Risk of an HBV positive mother transmitting to infant at time of delivery

Answer 3

90%

Question 4

Leukopenia in alcoholics

Answer 4

Occasionally seen but resolves after cessation of drinking

Question 5

CBC issues possibly seen in alcoholics

Answer 5

1. high or low WBCs
2. Anemia
3. Folic acid deficiency
4. Thrombocytopenia

Question 6

Mallory (Mallory-Denk) bodies

Answer 6

Alcoholic hyaline seen on liver biopsy in alcoholic liver disease

Question 7

What happens if you administer glucose without thiamine in alcohol-induced liver disease

Answer 7

Can precipitate Wernicke Korsakoff

Question 8

Three major treatments for severe alcoholic hepatitis

Answer 8

1. Steroids
2. Pentoxifylline
3. Liver transplant

Question 9

Requirement for liver transplant for alcohol-induced liver disease

Answer 9

Must abstain from alcohol for 6mo to be considered

Question 10

Three scores for severity of alcohol-induced liver disease + the score that indicates a poor prognosis

Answer 10

1. Maddrey’s discrimination function (DF): 32
2. Glasgow Alcoholic hepatitis score: 9
3. MELD: model for end-stage liver disease: 21

Question 11

Wernicke Korsakoff sx

Answer 11

AMS, ataxia, involuntary eye movements (nystagmus)

Question 12

Korsakoff sx

Answer 12

Severe memory issues, confabulation

Question 13

Treatment for Wernicke encephalopathy

Answer 13

Thiamine

Question 14

Two things that protect against NAFLD

Answer 14

1. physical activity

2. Coffee consumption

Question 15

What is seen on liver biopsy in NAFLD

Answer 15

Macrovesicular steatosis +/- inflammation and fibrosis, PMN infiltrate, Mallory hyaline - indistinguishable from alcoholic steatohepatitis

Question 16

Lung disease seen in a1 antitrypsin deficiency

Answer 16

Pan-acinar emphysema in lower lobes (smokers get emphysema in upper lobes)

Question 17

Most commonly diagnosed inherited hepatic disorder in infants/children

Answer 17

A1 antitrypsin deficiency

Question 18

PiM, PIS, PiZ and PiZZ phenotypes in a1AT deficiency

Answer 18

1. PiM: normal, most common
2. PIS: mildly reduced levels
3. PiZ: severe reduction
4. PiZZ: most severe reduction

Question 19

What is iron stored as + where is it stored in hemochromatosis

Answer 19

Hemosiderin -> liver, panc, heart, adrenals, testes, pituitary, kidneys

Question 20

Neurological manifestations in Wilson disease

Answer 20

Parkinson’s, tremor, ataxia, dysarthria, dysphagia, spasticity, migraines, insomnia, seizure

Question 21

How to check for SBP?

Answer 21

Paracentesis

Question 22

Two major scores to calculate for cirrhosis

Answer 22

1. Child-Turcotte Pugh

2. MELD

Question 23

What to order for MELD vs Child-Turcotte-Pugh

Answer 23

MELD: bili, creat, Na, INR
CTP: bili, INR, albumin, assess for encephalopathy and ascites

Question 24

What two things should be monitored every 6 months in cirrhosis to monitor for HCC?

Answer 24

Alpha fetoprotein, US

Question 25

Three treatments for NAFLD

Answer 25

1. Weight reduction
2. Exercise
3. Control metabolic syndrome

Question 26

Three pt populations that need paracentesis for ascites

Answer 26

1. New onset ascites
2. Pts admitted to hospital with ascites
3. Known ascites deterioration

Question 27

What level of PMN suggests SBP in ascites?

Answer 27

250 mcL

Question 28

What does SAAG stand for?

Answer 28

Serum albumin- ascites gradient

Question 29

Four things that increase severity of esophageal varices

Answer 29

1. Size larger than 5mm
2. Red wale markings
3. Severity of liver disease
4. Active alcohol abuse

Question 30

Esophageal varices prevention drug

Answer 30

No selective beta-adrenergic blockers

Question 31

Major treatment for esophageal varices

Answer 31

Band ligation

Question 32

Treatment for hepatic encephalopathy + how it works

Answer 32

Lactulose -> colonic acidification and diarrhea