Cirrhosis

Question 1

Cirrhosis defined

Answer 1

Diffuse bridging fibrosis and nodular regeneration via Stella the cells that disrupt normal architecture

Question 2

Causes of cirrhosis

Answer 2

Alcohol (60%), chronic viral hepatitis, biliary disease, genetic/metabolic disorders

Question 3

Effects of portal hypertension

Answer 3

Esophageal varices (hematemesis)
peptic ulcer (melena)
Splenomegaly
Caput medusae, ascites
Gastropathy 
Anorectal varices

Question 4

Effects of liver cells failing

Answer 4

Hepatic encephalopathy
Sclera icterus
Fetor hepaticus (musty breath)
Spider nevi, Gyneocmastia, testicular atrophy (dt inc estrogen)
Jaundice
Asterixis (hand tremor)
Bleeding (dec clotting factors) inc PT
Ankle edema
Anemia

Question 5

Serum marker: alkaline phosphatase (ALP)

Answer 5

For cholestatic and obstructive hepatobiliary disease,
HCC
Infiltrative disorders
Bone disease

Question 6

Aminotransferases (AST and ALT) is for measuring

Answer 6

Liver enzymes
Viral hepatitis (ALT >AST)
Alcoholic hepatitis (AST > ALT)

Question 7

Amylase is for measuring

Answer 7

Acute pancreatitis

Mumps

Question 8

Ceruloplasmin is for diagnosing

Answer 8

Wilsons disease (it will be low)

Question 9

Y-glutamic transpeptidase (GGT) is for measuring

Answer 9

Increases in various liver and biliary diseases but not in bone disease
Associated with alcohol use

Question 10

Lipase is most specific for measuring

Answer 10

Acute pancreatitis

Question 11

Non-alcoholic fatty liver disease

Answer 11

Metabolic syndrome due to insulin resistance
Fatty infiltration of hepatocytes
Cellular ballooning and eventual necrosis
May cause cirrhosis and HCC
High ALT

Question 12

Hepatic encephalopathy cause

Answer 12

Cirrhosis, then portosystemic shunts, decrease in NH3 metabolism , then neuropsych dysfunction

High NH3 levels

Question 13

Hepatic encephalopathy presentation

Answer 13

Disorientation/ asterixis (mild) to difficult arousal or coma

Question 14

Increased NH3 production and absorption is from

Answer 14

Dietary protein, GI bleed, constipation, infection

Question 15

Decreased NH3 removal is due to

Answer 15

Renal failure, diuretics, bypassed hepatic blood flow post-TIPS

Question 16

Hepatic encephalopathy treatment

Answer 16

Lactulose to increase NH4 generation and

Rifaximin

Question 17

Diagnosis of HCC is always preceded by either

Answer 17

HBV or cirrhosis

Question 18

Portal HTN leads to

Answer 18

Thrombocytopenia (dt splenic sequestration)
Ascites
Encephalopathy
Varices

Question 19

For the diagnosis of spontaneous bacterial peritonitis one must have….

Answer 19

> 250 polys

Question 20

Treatment for ascites

Answer 20

Furosemide
Spironolactone
Therapeutic paracentesis
Fluid restricted diet (low salt and water)

Question 21

Portal hypertension intially leads to increased ____________, ____-_____ _________ and _________

Answer 21

Resistance
Porto-systemic collaterals
Splenomegaly

Question 22

Most common causes of cirrhosis

Answer 22

Alcohol
HCV
NASH
Autoimmune hepatitis
HBV
PBC
PSC
Hemochromatosis

Question 23

Decompensation physiology that leads to it

Answer 23

Portal HRN
Hyperdynamic circulation
Liver insufficiency

Question 24

Physical exam findings in compensated cirrhosis

Answer 24

Bitempotal muscle wasting
Spider nevi
Palmar erythema
Palpable left lobe of liver
Small liver span right lobe
Splenomegaly

(No ascites or encephalopathy)

Question 25

Lab findings in compensated cirrhosis

Answer 25

Low platelets AST >ALT Low albumin

Question 26

Compensated cirrhosis imaging findings

Answer 26

Nodular liver Collaterals Splenomegaly Ascites

Question 27

T ran silent elastography

Answer 27

US based test that tells how stiff the liver is

Question 28

Treat increased hepatic resistance with

Answer 28

Statins They increase nitric oxide bioavailability in the intrahepatic circulation Overall increased liver perfusion

Question 29

Therapies to prevent first time variceal hemorrhage

Answer 29

Endoscopic variceal ligation Non-selective beta blockers (propranolol, nadolol) will block increased flow from hypertension and decrease cardiac output Or carvedilol to dilate hepatic circulation

Question 30

Standard of care post-variceal hemorrhage

Answer 30

Prophylactic abx, IV vasopressors and ligation

Question 31

What does TIPS do?

Answer 31

Reduces portal pressure and decompressed varices

Question 32

What is TIPS

Answer 32

Transjugular intrahepatic portosystemic stent Connects hepatic vein and portal vein to reduce/ normalize portal pressure and decompress varices

Question 33

Most common decopensating event with highest mortality

Answer 33

Ascites

Question 34

What happens to splanchnic circulation during cirrhosis?

Answer 34

Vasodilates

Question 35

Sodium retention in cirrhosis leads to ________. We should treat it by

Answer 35

Ascites | Treat: sodium restriction, diuretics

Question 36

Spironolactone treats

Answer 36

Ascites

Question 37

Shit, now im having more sodium retention, refractory ascites, what DO I DO!?!?!?

Answer 37

Large volume paracentesis | IV albumin to vasoconstrict and minimize occurence of post-parachutes is circulatory dysfunction

Question 38

TIPS transfers blood volume from ______ to ______ circulation, increasing effective blood volume

Answer 38

Splanchnic to systemic

Question 39

Worst complication of ascites and frequent nt precipitation of hepatorenal syndrome

Answer 39

SBP Increases in creatinine Spontaneous infections

Question 40

what is one of the earliest signs of cirrhosis?

Answer 40

low platelets due to splenic sequestration