Cirrhosis

Question 1

L1: In portal hypertension, there is _______ resistance to portal flow and _______ portal venous inflow

Answer 1

increased; increased

Question 2

L1: Most sensitive diagnostic method for ascites

Answer 2

ultrasound

Question 3

L1: Normal HVPG = __

Answer 3

3-5 mmHg

Question 4

L1: What are the renal histologic finding in hepatorenal syndrome?

Answer 4

None; it is a functional renal failure

Question 5

L1: What is the cause of sinusoidal portal hypertension?

Answer 5

Cirrhosis

Question 6

L1: What is the definitive treatment for hepatorenal syndrome?

Answer 6

Liver Transplant

Question 7

L1: What is the most notable complication/sequela of TIPS?

Answer 7

Hepatic encephalopathy

Question 8

L1: Which procedure may be used to decreased sinusoidal pressure?

Answer 8

TIPS (Transjugular Intrahepatic Portal Shunt)

Question 9

L2: Following esophageal varices bleeding, HVPG should ideally be reduced to less than _____

Answer 9

12 mmHg

Question 10

L2: HVPG (_______) =

Answer 10

Hepatic venous pressure gradient; WHVP - FHVP

Question 11

L2: In cirrhosis, SAAG is _____ 1.1 and albumin is _____ 2.5

Answer 11

greater than; less than

Question 12

L2: In heart failure, SAAG is _____ 1.1 and albumin is _____ 2.5

Answer 12

greater than; greater than

Question 13

L2: In malignancy, SAAG is _____ 1.1 and albumin is _____ 2.5

Answer 13

less than; greater than

Question 14

L2: In tuberculosis, SAAG is _____ 1.1 and albumin is _____ 2.5

Answer 14

less than; greater than

Question 15

L2: Name 2 indications for TIPS

Answer 15

refractory variceal bleeding, refractory ascites

Question 16

L2: Name a vasoconstrictor used in treatment of esophageal varices

Answer 16

octreotide

Question 17

L2: SAAG = ______

Answer 17

Serum albumin - Ascities albumin

Question 18

L2: The serum-ascites albumin gradient (SAAG) has a correlation with _____.

Answer 18

sinusoidal pressure/HVPG

Question 19

L2: What CBC finding may be noted in patients with hepatic portal hypertension?

Answer 19

Thrombocytopenia

Question 20

L2: What factors are considered in the MELD score used to rank patients for liver transplant?

Answer 20

Bilirubin, Creatinine, INR

Question 21

L2: What is the cause of post-hepatic portal hypertension?

Answer 21

Budd-Chiari Syndrome

Question 22

L2: What is the cause of post-sinusoidal portal hypertension?

Answer 22

Veno-occlusive disease

Question 23

L2: What is the cause of pre-hepatic portal hypertension?

Answer 23

Portal or splanchnic vein thrombosis

Question 24

L2: What is the cause of pre-sinusoidal portal hypertension?

Answer 24

Schistosomiasis

Question 25

L2: What is the most common cause of Spontaneous Bacterial Peritonitis?

Answer 25

Gram-negative rods (E. coli)

Question 26

L2: What is the treatment for spontaneous bacterial peritonitis?

Answer 26

3rd generation cephalosporin or amoxicillin+clavulanate

Question 27

L2: Which causes of portal hypertension cause increased HVPG?

Answer 27

Sinusoidal and post-sinusoidal causes

Question 28

L3: Medical treatment for esophageal varices

Answer 28

Vasoconstrictors and venodilators

Question 29

L3: Name 2 treatment strategies for hepatic encephalopathy.

Answer 29

Lactulose; rifaximin

Question 30

L4: MELD Score = ________

Answer 30

6.4 + 9.8*log(INR) + 11.2*log(Creatinine) + 3.4*log(Bilirubin)

Question 31

L4: Name 6 risk factors/precipitants for hepatic encephalopathy.

Answer 31

Diuretics, TIPS, high protein intake, infection, sedatives, GI bleeding