Cirrhosis Flashcards
What is diagnostic study is useful in diagnosing Cirrhosis?
U/S: determines liver size & evaluates for hepatocellular carcinoma
What is Cirrhosis?
Irreversible liver fibrosis with nodular regeneration 2ndary to chronic liver disease
- These nodules cause increased portal pressure
- Macronodules associated with higher risk of HCC
What the potential causes of Cirrhosis?
- ETOH MC* in US
- Chronic viral hepatitis: HCV*
- Nonalcoholic fatty liver disease (Obesity, DM, & hypertriglyceridemia)*
- Hemochromatosis*
- Autoimmune hepatitis
- Primary biliary cirrhosis
- Primary sclerosing cholangitis
- Drug toxicity
Which of the following is not a general symptom of Cirrhosis?
A. Fatigue B. Weakness C. Weight loss D. Muscle cramps E. Anorexia F. Increased urination
F. Increased urination
A patient with Cirrhosis will often suffer from ascites. Explain why this occurs?
Abdominal distension by fluid due to decrease oncotic pressure - decrease hepatic production of protein
A patient with Cirrhosis will often suffer from gynecomastia. Explain why this occurs?
Liver is unable to metabolize the estrogen
Which of the following is not a PE finding of Cirrhosis?
A. Dupuytren's contractures B. Jaundice C. Gynecomastia D. Nausea E. Palmar erythema F. Muscle wasting G. Caput medusa H. Spider Angioma
D. Nausea
A patient is admitted for confusion and lethargy. On PE, you notice the patient has a flapping tremor and fetor hepaticus. Labs reveal increased ammonia levels. What is the most likely diagnosis?
Hepatic encephalopathy
Patients with Cirrhosis can have esophageal varices; why is this?
Due to portal HTN
A patient is admitted for confusion and lethargy. On PE, you notice the patient has a flapping tremor and fetor hepaticus. What would you expect lab results to reveal?
Increased ammonia
A patient is admitted for confusion and lethargy. On PE, you notice the patient has a flapping tremor and fetor hepaticus. Labs reveal increased ammonia levels. What is the best management for this patient?
- Encephalopathy: Lactulose or Rifaximin
Neomycin is 2nd line - Ascites: Na+ restriction –> diuretics (Spironolactone, Furosemide); Paracentesis
- Pruritis: Cholestyramine (Questran)
What is the definitive management for Cirrhosis?
Liver transplant
What is the MOA of Cholestyramine?
It is a bile acid sequestrant that reduces bile salts in the skin, leading to less irritation from the bile salts
How is screening for Hepatocellular carcinoma done?
U/S + alpha fetoprotein
What is the MOA of Rifaximin & Neomycin?
Abx that decrease the ammonia-producing flora
