Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Liver Diseases > CIrrhosis > Flashcards

CIrrhosis Flashcards

1
Q

What is the positive likelihood ratio of platelet <160k for cirrhosis?

A

6.3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what is the median survival for compensated cirrhosis? decompensated cirrhosis?

A

compensated cirrhosis - 12 yrs

decompensated cirrhosis - 1.5 yrs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what is the estimated annual rate of variceal bleeding in cirrhotics?

A

5-15% annual rate of variceal bleed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what are the most important predictors of hemorrhage for varices?

A

most important: variceal size

runner up: decompensated cirrhosis, red wale sign

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

recommended tx for secondary ppx of variceal hemorrhage - NSBB or EVL?

A

trick question! for secondary ppx of variceal bleed, do both NSBB and EVL.

median rebelled rate in untx’d pts is 60% w/n the first 2 yrs.

so when you scope an active variceal bleeder, do both.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

how soon should endoscopy performed for cirrhotics w/ GI bleed?

A

w/n 12 hrs of presentation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

which pts are candidates for preemptive “early” TIPS for variceal bleeds?

A
  1. pts w/ Child C (score 10-13) cirrhosis
    or
  2. pts w/ Child Class B w/ active hemorrhage at endoscopy

studies show that early TIPS w/n 72hrs of diagnostic endoscopy is associated w/ improved outcomes including survival

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the contraindications of TIPS?

A
  • advanced age
  • HCC
  • heart failure
  • significant encephalopathy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what is the recommended starting dose for spironolactone for ascites?

A

50-100mg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

which hospitalized pts w/ ascites should get a diagnostic paracentesis? why?

A

ALL hospitalized cirrhotics w/ ascites should get diagnostic paras to exclude SBP, since up to 1/3 of pts w/ SBP may be entirely asymptomatic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what is the differential for ascites w/ SAAG > 1.1 and ascites protein >2.5?

A

post-sinusoidal hypertension - etiologies include cardiac ascites, Budd-Chiari, and veno-occlusive disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what are the indications for abx ppx for cirrhotics?

A
  1. GI bleed
  2. secondary ppx of SBP in select pts (maybe if ascites protein < 1 or (Child Pugh >9 pts w/ Bili >3, Cr >1.2, BUN < 25, or Na < 130)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

name some precipitants of hepatic encephalopathy?

A

80% of HE is precipitant-induced

  • dehydration
  • infection
  • overdiuresis
  • GI bleed
  • constipation
  • narcotics and/or sedatives

Goal: ID and tx the precipitant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what are the benefits of rifaximin in HE?

A

Rifaximin is used for management of recurrent or persistent HE despite adequate titration of lactulose.

Rifaximin is also effective in maintaining remission in pts w/ recurrent HE, and decreases HE-related hospitalizations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

most common type of AKI in cirrhotics?

A

albumin-responsive pre-renal AKI

consider ATN and HRS in ddx. Start midodrine and octreotide if renal function doesn’t respond to albumin and other causes of AKI are ruled out

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

True or False - a cirrhotic should be referred for liver transplant after their first decompensation event, REGARDLESS OF THEIR MELD SCORE

A

TRUE!!!

even if they have a low MELD, they should be referred for liver transplant at their first decompensation since median survival for decompensated cirrhosis is 1.5 yrs

17
Q

What is Milan criteria?

A

3 lesions each <=3cm or 1 lesion <=5cm

If pt has HCC lesions that fit Milan criteria, they are candidates for liver transplant

18
Q

Options for tx for HCC?

A

if fits Milan criteria, liver transplant

if single lesion w/ good liver function and minimal portal HTN, resection.

For nonsurgical candidates w/ decent liver function, consider TACE.

Consider ablation +/- TACE as a bridge to liver transplant for controlling tumor burden

Sorafenib for advanced HCC who are poor candidates for locoregional tx

19
Q

conditions that give MELD exception points

A
  • hereditary hypercholesterolemia
  • hereditary hyperoxaluria
  • primary hyperoxaluria
  • familial amyloid polyneuropathy
  • polycystic liver disease
  • HCC
  • HPS (if PaO2 <60)
  • PPS
20
Q

dx criteria for hepatopulmonary syndrome?

A
  • exclude cardiopulmonary disease
  • PaO2 < 80
  • A-a gradient >15
  • presence of late bubbles on TTE bubble study
21
Q

what is portopulmonary hypertension

A

portopulmonary hypertension (POPH) results from pulmonary vasoconstrictors that are released from the splanchnic circulation.

dx - R heart cath shows PAP > 25, PCWP < 15 (which excludes L heart failure as etiology of pulm HTN), pulm vascular resistance > 240, presence of portal HTN

22
Q

what level of portopulmonary hypertension is a contraindication for liver transplant?

A

mean PAP > 50

if mean PAP can be reduced to < 35 w/ vasodilators and pulmonary vascular resistance to < 400, transplant is possible.

23
Q

what are the most common early post-transplant complications?

A
  • acute cellular rejection
  • hepatic artery thrombosis
  • biliary stricture
24
Q

how do you diagnose acute cellular rejection s/p liver transplant?

A

acute cellular rejection occurs in 20-30% of transplant recipients.

On histology:

  • mixed infiltrate in portal triad (predominantly lymphocytic)
  • (non)-destructive nonsuppurative cholangitis w/ ductulitis (interlobular bile duct epithelium)
  • endotheliitis
25
Q

how do you treat acute cellular rejection in liver transplant pts?

A

1st line tx - high dose steroids

26
Q

hepC cirrhosis s/p transplant w/ abnormal LAEs. next step? what ddx must you consider?

A

liver bx is the only way to distinguish b/w acute cellular rejection vs recurrent hepC

27
Q

how can you distinguish on histology b/w acute cellular rejection vs recurrent hep C?

A

acute cellular rejection - central endotheliitis

recurrent hep C - lobular hepatitis

28
Q

what kinds of cancers are common among solid organ transplant recipients?

A

development of skin cancers - notably SCC and BCC

29
Q

what are 2 ways you can distinguish cardiac ascites vs cirrhosis as the cause of portal HTN?

A

in cardiac ascites, HVPG is normal and the ascites protein is >2.5

30
Q

what is the surveillance interval for variceal screening/monitoring EGD’s in cirrhotics?

A

no varices - q2-3yrs

small varices w/o red wale sign and no child C - NSBB or q1-2yr

small varices w/ red wale sign or Child C - NSBB

medium/large varices - NSBB or EVL

31
Q

what are the goals of nadolol, propranolol, and carvedilol?

A

nadolol - titrate to resting HR 50-55, max 80mg/d

propranolol - titrate to resting HR 50-55, max 160mg/d

carvedilol - max 12.5mg/d

32
Q

pathophys of NSBB?

A

NSBB reduce portal pressure by reducing portal venous inflow by reducing cardiac output (by beta1 blockade) and by causing splanchnic vasoconstriction (by beta2 blockade)

33
Q

what is the dose of albumin for SBP?

A

day 1 - 1.5g/kg
day 3 - 1g/kg

reduces rate of AKI and improves survival
doses are pretty arbitrary

Liver Diseases (2 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions