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HEPATOLOGY > Case: DECOMPENSATED LIVER DISEASE > Flashcards

Case: DECOMPENSATED LIVER DISEASE Flashcards

1
Q

Causes of Abdominal Distension
🧠⚡6F⚡

A
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2
Q

How to differentiate that Abdominal Distension is DUE TO: Fluid?

A
  1. Diffuse
  2. Changes with Position
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3
Q

Causes of ASCITES

A

CVS
➡️ 1. Right Heart Failure
Liver disease
➡️ Portal HYPERTENSION
Renal
➡️ Nephrotic Syndrome
➡️ Chronic Kidney Disease
Malnutrition
Peritoneal Causes
➡️ Peritonitis
➡️ TB
GI
➡️ Protein losing enteropathy
➡️ Malabsorption syndrome

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4
Q

Ascites ➕ Pedal Edema causes
🧠⚡ All Causes except Peritoneal causes ⚡
🧠⚡ Same as Anasarca⚡

A
  1. Nephrotic Syndrome
  2. Rt Heart Failure
  3. Liver causes
  4. Malabsorption
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5
Q

Anasarca

A

Generalized Edema
➕
Serosal Cavities
✨ Pericardial
✨ Pleural
✨ Peritoneal

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6
Q

Thiamine deficiency causes ANASARCA

A
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7
Q

What does DECOMPENSATION mean in Cirrhosis

A

Presence of new Onset:
1. Hepatic Encephalopathy
2. Jaundice
3. Ascites (DUE TO: Portal HYPERTENSION)
4. GI Bleed

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8
Q

Type of Jaundice in Cirrhotic Patient

A

Hepatocellular Jaundice

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9
Q

Hemolytic JAUNDICE
Supporting Features

A
  1. Itching ⛔
  2. NORMAL Color stools
  3. High Coloured Urine (Becomes Clear on Jaundice)
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10
Q

Obstructive JAUNDICE
Supporting Features

A
  1. Clay Coloured Stools
  2. Itching ➕
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11
Q

Why Obstructive Jaundice causes itching?

A

Bile Salts ⬆️ ⬆️
⬇️
Emulsify or saponify the Myelin sheath
⬇️
Nerve Ends gets Exposed
⬇️
Stimulated ➡️ Itching sensation

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12
Q

Cause of Acute Onset Hepatocellular Jaundice

A

✨ HEPATITIS
Viral, Toxins, Alcoholism

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13
Q

Cause of FEVER in Cirrhosis

A
  1. Spontaneous Bacterial Peritonitis
  2. Hepatitis
  3. Infections
  4. Malignancy ➡️ Hepatocellular CARCINOMA HCC
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14
Q

Can Cirrhosis patient have FEVER without any cause?

A

Yes
TNF & Other Cytokine metabolism is disturbed in the liver
⬇️
Fever

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15
Q

Altered Sleep Wake Cycle is a feature of

A

All ENCEPHALOPATHIES
✨ Uremic
✨ CO2
✨ Hepatic

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16
Q

Precipitating factors for HEPATIC ENCEPHALOPATHY

A
  1. GI Bleeding
  2. Constipation
  3. INFECTIONS & Sepsis
  4. Dehydration
  5. Metabolic abnormalities
    ✨ Hypokalemia
    ✨ Hyponatremia
    ✨ Metabolic Alkalosis
  6. Renal Failure
  7. HIGH PROTEIN DIET
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17
Q

How COVID 19 can cause HEPATITIS?

A
  1. Macrophage Activation Syndrome ➡️ Hepatitis
  2. Drugs used for treating Covid 19
    ✨ Paracetamol
    ✨ Dexamethasone
18
Q

Portal HYPERTENSION cannot be diagnosed without

A

GI Bleeding

19
Q

⚡⚡ MOST COMMON CAUSE of CIRRHOSIS in INDIA & WORLD

A

HEPATITIS C infection > Alcoholic Liver disease

20
Q

Why important to know HCV is ⚡⚡ MOST Important cause of Cirrhosis

A
  1. Preventable & Treatable
  2. Further Complications like HCC predictable
  3. Transmission to others possible
21
Q

Recurrent Jaundice in Young
Cause

A

Viral HEPATITIS

22
Q

⚡⚡ MOST COMMON CAUSE of CIRRHOSIS IN YOUNG

A

Wilson’s disease

23
Q

Is Jaundice a Feature of CIRRHOSIS

A

⭐ NO
Can be present only if
✨ Hepatitis in the regenerating nodules
✨ HCC

24
Q

Cause of Pitting Edema in Cirrhosis

A

2° HYPERALDOSTERONISM

Cause: Intravascular Hypovolemia DUE TO: Splanchnic Vasodilation in CIRRHOSIS
⬇️
RAAS Activation

25
Q

Cause of Cyanosis in CIRRHOSIS

A
  1. Hepatopulmonary syndrome
  2. Pleural Effusion
26
Q

Platypnea is a characteristic feature of

A

Hepatopulmonary Syndrome

27
Q

Causes of CLUBBING in Cirrhosis

A
  1. 1° Biliary Cirrhosis
  2. HCC
28
Q

Why Hair is space in CIRRHOSIS ?

A

Protein deficiency ➡️ Hair sparcity

29
Q

Which Hairs Growth are affected by Estrogen & Testesterone

A

Axillary & Pubic Hair

30
Q

Hair Complaint showing Estrogen predominant in Liver CIRRHOSIS

A

⬇️ shaving Frequency

31
Q

Low BP in Cirrhosis

A
  1. Sepsis
  2. Upper GI Bleed
32
Q

Signs of CIRRHOSIS specifically caused by ALCOHOL

A
  1. Parotid Enlargement & Lacrimal Gland Enlargement
  2. Dupuytren’s contracture
33
Q

Cause of Palmar Erythema

A

Peripheral Vasodilation DUE TO: ⬆️⬆️ Estrogen / Androgen ratio

34
Q

How to differentiate Palmar Erythema of Polycythemia & Liver CIRRHOSIS

A

In Liver Cirrhosis: Only Thenar & Hypothenar redness & Central sparing
⬇️
Why?
⬇️
Anatomical distributor of blood vessels

⭐ In Polycythemia ➡️ Entire Palm is red

35
Q

Paper Money Skin

A

Numerous small vessels scattered randomly through the skin ln upper Arma

36
Q

How to clinically demonstrate Spider Nevi?

A

Apply pressure over Body of spider with GLASS SLIDE (Diascopy)
⬇️
Blanching
⬇️
Refilling after release of pressure

37
Q

Difference BETWEEN Venous Star & Spider Nevi?

A
  1. Blood flow OPPOSITE to that of Spider nevi
  2. Bluish coloured
  3. Pattern, shape & size VARIABLE
  4. ➕ on Dorsum of foot, around ankle, lower leg
  5. Composed of Dilated Veins
38
Q

Patients with Spider Nevi with size > 15 mm

A

80% chances of Variceal Bleeds
Hepatic Fibrosis ⬆️
Mortality ⬆️

39
Q

Causes of Pseudogynecomastia

A
  1. Obesity
  2. Cushing Syndrome
40
Q

Young ♂️ with Gynecomastia, always rule out

A

Testicular Tumors

41
Q

Flapping Tremors vs Tremors

A

Flapping Tremors
🎯One way Jerking movement
🎯 Negative Myoclonus

Tremors
🎯 To & Fro movement

42
Q

Cause of Astirixis

A

Reticular Activating System ⛔
⬇️
Momentarily Loss of Joint sense & Position

HEPATOLOGY (16 decks)

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