Cirrhosis Flashcards
The histologic characterization of cirrhosis is ___________.
fibrosis with regenerative nodules
There are two kinds of cirrhosis: ________________.
- compensated: no complications
- uncompensated: complications (portal hypertension – leading to varices and ascites – and liver insufficiency –leading to encephalopathy and jaundice)
Hypertrophy of which liver lobe is indicative of cirrhosis?
The caudate
True or false: biopsy is needed for definitive diagnosis of cirrhosis.
False. Cirrhosis can be diagnosed on CT or by clinical features –even to the point of transplant list! Only do a biopsy if someone has chronic liver disease and no other manifestations of cirrhosis.
What five criteria are in the Child-Turcotte-Pugh scale?
- ascites
- encephalopathy
- bilirubin
- albumin
- PT/INR
The MELD scale includes which three serum values?
- creatinine
- bilirubin
- PT/INR
The most common cause of portal hypertension is ___________.
cirrhosis
Post-sinusoidal occlusion often results from what kind of medical intervention?
Myeloablative therapy (for cancer)
What two things happen in cirrhosis that leads to portal hypertension?
(1) Fibrosis leads to structural interference
(2) Destruction of endothelial cells leads to decreased NO release and subsequent increase in vasoconstriction (whereas in healthy tissue, increased flow would lead to increased NO release and subsequent vasodilation)
The definitive diagnostic test for cirrhosis is _____________.
hepatic venous pressure gradient (HVPG)
HVPG is normal in ____________ portal hypertension, while it will be elevated in ____________________ portal hypertension.
pre-hepatic, pre-sinusoidal, and post-hepatic; sinusoidal and post-sinusoidal
______________ esophageal varices are more likely to rupture.
Large (which increase the wall tension)
Esophageal varices can be treated with ____________.
endoscopic band ligation
There is a surgical treatment for cirrhosis that is analogous to drilling a hole through the liver. What is it?
Transjugular intrahepatic portosystemic shunt –connecting the hepatic portal vein to the hepatic vein.
What is the use of octreotide? (This is going to be on the exam!) “Give octreotide before calling the GI fellow.”
It causes vasoconstriction in the splanchnic vasculature. This causes constriction of the stomach/esophageal veins, leading to temporary inhibition of bleeding.
The most common cause ascites is ___________.
cirrhosis (80%)
One of the things that induces sodium retention is _____________.
over dilation of the splanchnic vasculature (from portal hypertension)
After paracentesis, what calculation can be done to help diagnose ascites?
(serum albumin) –(ascites albumin)
If this is greater than 1.1, this is cirrhotic ascites. (This also correlates well with HVPG.)
______________ often presents earlier than hypoalbuminemia or prolonged INR in those with cirrhosis.
Thrombocytopenia (because of hypersplenism)
The CTP scale goes from 5 to 15. You need a score of at least _______ to be put on the transplant list.
7
MELD stands for ________________.
Model for End-stage Liver Disease
In cirrhosis, the site of increased resistance is ______________.
sinusoidal
List the sites which can cause portal hypertension and the most common cause of each.
- pre-hepatic: portal vein thrombosis
- pre-sinusoidal: Schistosomiasis
- sinusoidal: cirrhosis
- post-sinusoidal: veno-occlusive disease
- post-hepatic: Budd-Chiari or CHF
Normal HVPG is ________.
3 to 6 mmHg
