Cirrhosis Flashcards
L1: In portal hypertension, there is _______ resistance to portal flow and _______ portal venous inflow
increased; increased
L1: Most sensitive diagnostic method for ascites
ultrasound
L1: Normal HVPG = __
3-5 mmHg
L1: What are the renal histologic finding in hepatorenal syndrome?
None; it is a functional renal failure
L1: What is the cause of sinusoidal portal hypertension?
Cirrhosis
L1: What is the definitive treatment for hepatorenal syndrome?
Liver Transplant
L1: What is the most notable complication/sequela of TIPS?
Hepatic encephalopathy
L1: Which procedure may be used to decreased sinusoidal pressure?
TIPS (Transjugular Intrahepatic Portal Shunt)
L2: Following esophageal varices bleeding, HVPG should ideally be reduced to less than _____
12 mmHg
L2: HVPG (_______) =
Hepatic venous pressure gradient; WHVP - FHVP
L2: In cirrhosis, SAAG is _____ 1.1 and albumin is _____ 2.5
greater than; less than
L2: In heart failure, SAAG is _____ 1.1 and albumin is _____ 2.5
greater than; greater than
L2: In malignancy, SAAG is _____ 1.1 and albumin is _____ 2.5
less than; greater than
L2: In tuberculosis, SAAG is _____ 1.1 and albumin is _____ 2.5
less than; greater than
L2: Name 2 indications for TIPS
refractory variceal bleeding, refractory ascites
L2: Name a vasoconstrictor used in treatment of esophageal varices
octreotide
L2: SAAG = ______
Serum albumin - Ascities albumin
L2: The serum-ascites albumin gradient (SAAG) has a correlation with _____.
sinusoidal pressure/HVPG
L2: What CBC finding may be noted in patients with hepatic portal hypertension?
Thrombocytopenia
L2: What factors are considered in the MELD score used to rank patients for liver transplant?
Bilirubin, Creatinine, INR
L2: What is the cause of post-hepatic portal hypertension?
Budd-Chiari Syndrome
L2: What is the cause of post-sinusoidal portal hypertension?
Veno-occlusive disease
L2: What is the cause of pre-hepatic portal hypertension?
Portal or splanchnic vein thrombosis
L2: What is the cause of pre-sinusoidal portal hypertension?
Schistosomiasis
L2: What is the most common cause of Spontaneous Bacterial Peritonitis?
Gram-negative rods (E. coli)
L2: What is the treatment for spontaneous bacterial peritonitis?
3rd generation cephalosporin or amoxicillin+clavulanate
L2: Which causes of portal hypertension cause increased HVPG?
Sinusoidal and post-sinusoidal causes
L3: Medical treatment for esophageal varices
Vasoconstrictors and venodilators
L3: Name 2 treatment strategies for hepatic encephalopathy.
Lactulose; rifaximin
L4: MELD Score = ________
6.4 + 9.8log(INR) + 11.2log(Creatinine) + 3.4*log(Bilirubin)
L4: Name 6 risk factors/precipitants for hepatic encephalopathy.
Diuretics, TIPS, high protein intake, infection, sedatives, GI bleeding