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Exam 3 > Cirrhosis > Flashcards

Cirrhosis Flashcards

1
Q

Cirrhosis defined

A

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

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2
Q

Causes of cirrhosis

A

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

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3
Q

Effects of portal hypertension

A 
Esophageal varices (hematemesis)
peptic ulcer (melena)
Splenomegaly
Caput medusae, ascites
Gastropathy 
Anorectal varices
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4
Q

Effects of liver cells failing

A 
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
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5
Q

Serum marker: alkaline phosphatase (ALP)

A

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

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6
Q

Aminotransferases (AST and ALT) is for measuring

A 
Liver enzymes
Viral hepatitis (ALT >AST)
Alcoholic hepatitis (AST > ALT)
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7
Q

Amylase is for measuring

A

Acute pancreatitis

Mumps

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8
Q

Ceruloplasmin is for diagnosing

A

Wilsons disease (it will be low)

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9
Q

Y-glutamic transpeptidase (GGT) is for measuring

A

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

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10
Q

Lipase is most specific for measuring

A

Acute pancreatitis

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11
Q

Non-alcoholic fatty liver disease

A

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

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12
Q

Hepatic encephalopathy cause

A

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

High NH3 levels

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13
Q

Hepatic encephalopathy presentation

A

Disorientation/ asterixis (mild) to difficult arousal or coma

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14
Q

Increased NH3 production and absorption is from

A

Dietary protein, GI bleed, constipation, infection

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15
Q

Decreased NH3 removal is due to

A

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

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16
Q

Hepatic encephalopathy treatment

A

Lactulose to increase NH4 generation and

Rifaximin

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17
Q

Diagnosis of HCC is always preceded by either

A

HBV or cirrhosis

18
Q

Portal HTN leads to

A

Thrombocytopenia (dt splenic sequestration)
Ascites
Encephalopathy
Varices

19
Q

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

A

> 250 polys

20
Q

Treatment for ascites

A

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

21
Q

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

A

Resistance
Porto-systemic collaterals
Splenomegaly

22
Q

Most common causes of cirrhosis

A 
Alcohol
HCV
NASH
Autoimmune hepatitis
HBV
PBC
PSC
Hemochromatosis
23
Q

Decompensation physiology that leads to it

A

Portal HRN
Hyperdynamic circulation
Liver insufficiency

24
Q

Physical exam findings in compensated cirrhosis

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

(No ascites or encephalopathy)

25
Q

Lab findings in compensated cirrhosis

A

Low platelets
AST >ALT
Low albumin

26
Q

Compensated cirrhosis imaging findings

A

Nodular liver
Collaterals
Splenomegaly
Ascites

27
Q

T ran silent elastography

A

US based test that tells how stiff the liver is

28
Q

Treat increased hepatic resistance with

A

Statins
They increase nitric oxide bioavailability in the intrahepatic circulation

Overall increased liver perfusion

29
Q

Therapies to prevent first time variceal hemorrhage

A

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

30
Q

Standard of care post-variceal hemorrhage

A

Prophylactic abx, IV vasopressors and ligation

31
Q

What does TIPS do?

A

Reduces portal pressure and decompressed varices

32
Q

What is TIPS

A

Transjugular intrahepatic portosystemic stent

Connects hepatic vein and portal vein to reduce/ normalize portal pressure and decompress varices

33
Q

Most common decopensating event with highest mortality

A

Ascites

34
Q

What happens to splanchnic circulation during cirrhosis?

A

Vasodilates

35
Q

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

A

Ascites

Treat: sodium restriction, diuretics

36
Q

Spironolactone treats

A

Ascites

37
Q

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

A

Large volume paracentesis

IV albumin to vasoconstrict and minimize occurence of post-parachutes is circulatory dysfunction

38
Q

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

A

Splanchnic to systemic

39
Q

Worst complication of ascites and frequent nt precipitation of hepatorenal syndrome

A

SBP

Increases in creatinine
Spontaneous infections

40
Q

what is one of the earliest signs of cirrhosis?

A

low platelets due to splenic sequestration

Exam 3 (18 decks)

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