Cirrhosis

Question 1

what four veins form the portal vein?

Answer 1

superior mesenteric
splenic
gastric
inferior mesenteric

Question 2

what may be present at a portocaval anastomosis?

Answer 2

varices

Question 3

what are the two classes of cause of portal hypertension?

Answer 3

prehepatic

intrahepatic

Question 4

what are the three most common causes of cirrhosis?

Answer 4

alcohol
hepatitis C
NASH

Question 5

what are the two kinds of cirrhosis?

Answer 5

compensated

decompensated

Question 6

what is the clinical presentation of compensated cirrhosis?

Answer 6

it is clinically normal

Question 7

when is compensated cirrhosis found?

Answer 7

incidentally i.e. LFT’s or imaging abnormalities

Question 8

what may be present in compensated cirrhosis?

Answer 8

portal hypertension

Question 9

what is decompensated cirrhosis?

Answer 9

liver failure, the end stage of liver disease

Question 10

name three possible causes of decompensated cirrhosis

Answer 10

infection
insult
SIRS

Question 11

name four signs associated with decompensated cirrhosis

Answer 11

jaundice
ascites
encephalopathy
bruising

Question 12

name five possible complications of cirrhosis

Answer 12

ascites 
encephalopathy 
variceal bleeding 
liver failure 
hepatocellular carcinoma

Question 13

how can ascites be diagnosed?

Answer 13

shifting dullness on percussion

ultrasound

Question 14

what are the two general principles for treating decompensated cirrhosis?

Answer 14

remove/treat underlying cause

treat any infection present

Question 15

what does SBP stand for?

Answer 15

spontaneous bacterial peritonitis

Question 16

what is SBP?

Answer 16

a translocated bacterial infection of ascites

Question 17

what should be done to look for SBP?

Answer 17

tap ascites, neutrophils will be over 250 if there is SBP

Question 18

what drug should not be given in ascites?

Answer 18

NSAIDs

Question 19

what diuretic should be given first for ascites?

Answer 19

spironolactone

Question 20

what two procedures can be done to relieve symptoms and reduce ascites?

Answer 20

paracentesis

TIPSS

Question 21

what three thinks are possible risks in paracentesis?

Answer 21

infection
encephalopathy
hypovolaemia

Question 22

what does TIPPS stand for?

Answer 22

trans jugular intra-hepatic porto systemic shunts

Question 23

what diuretics should be given in recurrent ascites?

Answer 23

spironolactone and a loop diuretic

Question 24

what needs to be monitored frequently in a patient with ascites?

Answer 24

U&E

Question 25

what three things are done to treat encephalopathy?

Answer 25

treat cause
lactulose to clear the gut
maintain nutritional status

Question 26

what should be considered in spontaneous encephalopathy?

Answer 26

transplantation

Question 27

what two treatments are used as primary prophylaxis for oesophageal varices in patients with cirrhosis?

Answer 27

beta blockers

variceal ligation

Question 28

what three things are done to treat acute variceal bleeding?

Answer 28

resuscitation
pharmacological therapy
endoscopic banding

Question 29

what drug is given when a patient has acute variceal bleeding?

Answer 29

terlipressin

Question 30

what should be done if treatment for acute variceal bleeding fails?

Answer 30

TIPSS

Question 31

what two things are done as secondary prophylaxis for variceal bleeding?

Answer 31

variceal band ligation

beta blockers