4.1.2 Cirrhosis: Pathophysiology and Managment

Question 1

What are the major molecules indicated in cirrhosis?

Answer 1

Inflammatory cytokines

Question 2

If patiets have abnormal renal function how could this affect your paracentesis?

Answer 2

Increased risk of bleeding

Question 3

What is an important drug to be added to lactulose

Answer 3

rifaximin

Question 4

What is cirrhosis?

Answer 4

Bridging fibrous septae ranging from delicate bands to broad scars

Not strictly end stage of hepatic scarring

Progressive fibrosis

Question 5

What are the indications for a diagnositic paracentesis?

Answer 5

Question 6

What is the major source of the excess collagen in the liver?

Answer 6

Stellate cell - stimulated shifts from a resting phenotype to an active

Question 7

What is this an image of?

Answer 7

Cirrhotic liver

Question 8

What are the three lab values that attribute to the MELD score?

Answer 8

Creatinine, bili and INR

Question 9

How are patients screen for esophageal varicies?

Answer 9

EGD

Done every 2-3 years in compensated disease

Annully in patients with decompensated disease

Question 10

What is the first step in the management of ascities in cirrhosis patients?

Answer 10

Salt restriction

Question 11

What is the main treatment for hepatic encephalopathy?

Answer 11

Lactulose - titrated to 3-5 stools per day

Question 12

What are the main complications of cirrhosis?

Answer 12

Ascites

Hepatic encephalopathy

Esophageal varicies and hemorrhage

Question 13

What percent of the cardiac output goes to the liver?

Answer 13

25% of cardiac output

Question 14

How do these three image relate to each other?

Answer 14

Question 15

What are the consequences of post-paracentesis circulatory dysfunciton?

Answer 15

ABSOLUTELY NEED TO GIVE ALBUMIN

Question 16

What is the next step in addressing ascities in cirrhosis after salt restriction?

Answer 16

Diuretic therapy

Spironolactone/furosemide

Question 17

What are the predictors of hemorrhage associated with esophageal varicies?

Answer 17

Variceal sign

Red sign

Child B/C

Question 18

What are the characteristics of band ligation?

Answer 18

Question 19

What are these images of?

Answer 19

Left - variceal hemorrhage

Right - varix with red signs

Question 20

What is becoming the most common cause of liver disease?

Answer 20

Non-alcohol fatty liver disease

Question 21

How would you describe the incoming blood flow to the liver?

Answer 21

Portal Vein

Hepatic artery

Question 22

What is a Tipps procedure?

Answer 22

Connection of the hepatic portal system to the systemic circulation

Question 23

What are the most common causes of liver disease in the US?

Answer 23

Hepatitis C virus infection

Alcohol overuse

Non-alcoholic fatty liver disease

Question 24

How would you manage patients with cirrhosis and no varicies?

Answer 24

B - blockers should not be used

Continued routine survellience

Question 25

How would you manage patients with cirrhosis and larger varicies

Answer 25

Question 26

What is the difference between intractable and resistant ascities?

Answer 26

Question 27

How would you manage a patient with cirrhosis and survived a esophageal bleed?

Answer 27

Question 28

What is this an image of?

Answer 28

Fibrosis of the liver

Question 29

How would you manage patients with cirrhosis and small varicies?

Answer 29

In patients who are at increased risk of bleeding - place on Beta blockers For those who are not at increased risk - follow up for screening

Question 30

How many people in the world are infected with HepC?

Answer 30

180 million or 3% of people

Question 31

What are the three main requirements for development of cirrhosis?

Answer 31

Cell death Deposition of extracellular matrix Vascular deorganization

Question 32

What is the importance of the MELD score?

Answer 32

Useful for prediction overall mortality associated with liver disease