cirrhosis

Question 1

compensated cirrhosis to decompensated cirrhosis
median survival for compensated cirrhosis
median survival for decompensated cirrhosis

Answer 1

ascites
jaundice
encephalopathy
variceal hemorrhage

9 years versus 1.6years

Question 2

What predicts the 3-months survival rate?
Which component is the most valued?
When to refer for liver transplant?

Answer 2

MELD SCORE 
INR 
Bi
Crea
30

Question 3

1 Y SURVIVAL

Answer 3

CHILD-TURCOTT-PUGH SCORE

Question 4

1# most common complication of cirrhosis.

Answer 4

Ascites

• not proven to use FFP or blood product
• a new one performs a paracentesis
• SAAG >1.1 97% accurate for portal hypertension

Question 5

ASCITES THERAPY

Answer 5

• sodium restriction 2000mg
• NO FLUID RESTRICTION
• ONCE daily diuretics 100-40 spironolactone and lasix
• painful gynecomastia use AMILORIDE instead of spironolactone
• BP low dc medications lowering blood pressure
• eval for liver transplant

Question 6

treatment for refractory ascites

Answer 6

one which does not respond to sodium restriction and diuretics

TIPS
OR LVP large volume paracentesis

Question 7

LVP large volume paracentesis

Answer 7

5L or more followed by 6g/L albumin infusion

Question 8

refractory ascites and BB

Answer 8

CONSIDER TO STOP

Question 9

DIURETIC THERAPY COMPLICATIONS

Answer 9

AKI
ENCEPHALOPATHY
HYPONATREMIA
HYPERKALEMIA

Question 10

HEPATORENAL SYNDROME CLINICAL FEATURES

Answer 10

Crea 1.5 or more
no improvement of creatinin after 2 days off diuretics
no improvement of creatinin after 1g/kg up to 100g iv albumin
bland urine sediment
absent of shock
absent of nephrotoxins

Question 11

2 types of hepatorenal syndrome

Answer 11

II —> I
I rising creatinin without liver transplant 1month survival
TRIGGER SBP

Question 12

Treatment of HRS

Answer 12

prevention with albumin
triple combination octreotide/albumin/midodrine
treatment of underlying condition eg alcoholic hepatitis
HD
liver transplant
DC BB

Question 13

sbp

Answer 13

most common trigger  HRS progression 
ATB CEFTRIAXON 5 DAYS 
DC BB
IF 
CREA >1
BUN 30
BI 4 
GIVE ALBUMIN DAY 1 AND DAY 3

Question 14

SECONDARY PREVENTION AND PRIMARY PREVENTION OF SBP

Answer 14

KIDNEY FAILURE CREA OVER 1.2 BUN 25
LIVER FAILURE BI OVER 3
PRIOR HISTORY OF SBP

Question 15

Prevention of SBP primary or secondary

Answer 15

TMT/SMT 1DS daily

cipro 500 daily

Question 16

Treatment of hepatic encephalopathy

Answer 16

lactulose - 2-4 BM if not tolerating rafaximin
trigger - infection, sedatives, bleed, constipation
do not restrict protein diet - catabolic state

Question 17

Hepatic encephalopathy

Answer 17

can be diagnosed and ammonia can be wnl.

Question 18

variceal bleeding and transfusions

Answer 18

restrictive transfusion approach 7-9
atb
EGD
TIPS

Question 19

CIRRHOSIS AND GI BLEEDING

Answer 19

GOAL PLATELETS >50
FFP
VIT K

Question 20

WHAT IMPROVES THE SURVIVAL RATE FOR VARICEAL BLEEDING?

Answer 20

TIPS

IT ALSO DECREASED THE RATE OF REBLEEDING

Question 21

What MELD is a threshold when the patient can live longer with a liver transplant versus without it?

Answer 21

15