Chronic Liver Disease

Question 1

The most common cause of liver cirrhosis in western countries

Answer 1

ALD

Question 2

2nd most common cause of liver cirrhosis after ALD is

Answer 2

Chronic hepatitis B and C

Question 3

Child pugh classification

Answer 3

Ascites.
Bilirubin.
Encephalopathy.
INR ratio.
Albumin.

Question 4

< 2 bilirubin is considered as ….. point in CP scoring.

Answer 4

1 point

Question 5

The most life threatening complication of portal hypertension

Answer 5

Bleeding (secondary to esophagogastric varices)

Question 6

The best way to manage and lower the portal HTN

Answer 6

Transjugular intrahepatic porto systemic shunt (TIPS)

Question 7

Varices management

Answer 7

1- IV fluids.
2- IV antibiotics.
3- IV octreotide.
4- Upper GI endoscopy (ligation or sclerotherapy).
5- Non selective B-blockers (prevents rebleeding).

Question 8

What is better for lowering the rate of rebleeding of varices, ligation or sclerotherapy?

Answer 8

Ligation

Question 9

DDx of ascites

Answer 9

• Cirrhosis.
• CHF.
• CRD.
• TB peritonitis.
• Malignancy.
• Hypoalbuminemia.

Question 10

Ascites in chronic liver disease is caused by

Answer 10

Portal HTN + Hypoalbuminemia

Question 11

The most common complication of cirrhosis

Answer 11

Ascites

Question 12

Serum ascites albumin gradient (SAAG) > 1.1

Answer 12

Portal HTN

Question 13

Indications of therapeutic paracentesis

Answer 13

• Tense ascites.
• SOB.
• Early satiety.

Question 14

Clinical features of hepatic encephalopathy

Answer 14

Decreased mental function - confusion - poor concentration - asterixis - rigidity - hyperreflexia

Question 15

Used to treat hepatic encephalopathy

Answer 15

Lactulose (prevents ammonia absorption) + Rifaximin (decrease ammonia production)

Question 16

Hepatorenal syndrome clinical features

Answer 16

• Azotemia.
• Oliguria.
• Hyponatremia.
• Hypotension.
• Low urine sodium.

Question 17

SBP causative organisms

Answer 17

• E. Coli.
• Klebsiella.
• Streptococcus pneumonia.

Question 18

WBC >500 + PMN>250 in the ascitic fluid is a sign of

Answer 18

SBP

Question 19

Coagulopathy in liver cirrhosis is treated by

Answer 19

Fresh frozen plasma

Question 20

Any patient with ascites + fever + mental changes. ……. should be suspected.

Answer 20

SBP