Cirrhosis

Question 1

What is the pathophysiology of pruritis?

Answer 1

Elevated levels of bile acids in the skin can act as pruritogens

Question 2

Lysophosphatidic acid and autotaxin can cause what?

Answer 2

pruritis

Question 3

What level was elevated in patients with pruritis in one study?

Answer 3

Studies show patients with cholestatic pruritis had much higher serum LPA levels and autotaxin activity.

Question 4

What is the treatment for cholestatic pruritis if the patient doesn’t have intrahepatic cholestasis of pregnancy or primary biliary cholangitis?

Answer 4

Bile acid sequestrant is 1st line:

–Cholestyramine (Questran) or colestipol (Colestid)

Question 5

What is 2nd line tx for cholestatic pruritis that reduces autotaxin?

Answer 5

Rifampin (Rifampicin)

Question 6

What is 3rd line tx for cholestatic pruritis?

Answer 6

opoid antagonist (naltrexone)

Question 7

Do antihistamines work for cholestatic pruritis?

Answer 7

No

Question 8

What is the MELD score used for?

Answer 8

Used to prioritize patients awaiting liver transplant

Question 9

What factors does the MELD

score use and what was just recently added?

Answer 9

• serum bilirubin
• creatinine
• INR
• Whether patient has had recent dialysis
• Na recently added
• *predicts 3-month survival

Question 10

__________ is a marker of how bad cirrhosis is and mortality

Answer 10

hyponatremia

Question 11

Each _______ in serum sodium increases mortality by ____%

Answer 11

decrease, 5%

Question 12

What is the management of variceal hemorrhage?

Answer 12

• egd screening/band ligation

- nonselective beta blocker (propanolol)

Question 13

What is the tx for ascites?

Answer 13

• Diuretics: Spironolactone/furosemide 100:40 ratio
• Paracentesis
• Sodium restriction

Question 14

treatment for Spontaneous Bacterial Peritonitis?

Answer 14

• Empiric antibiotics
• Cefotaxime
• Prophylactic antibiotics for patients who have previously had SBP

Question 15

treatment for Hepatic encephalopathy?

Answer 15

Lactulose/lactitol or rifaximin

Question 16

treatment for Hepatic hydrothorax?

Answer 16

Diuretics, sodium restriction

Question 17

treatment for Hepatocellular carcinoma?

Answer 17

• Surgical resection

* Liver transplant

Question 18

treatment for Hepatopulmonary syndrome?

Answer 18

• Liver transplantation

* Long-term oxygen therapy

Question 19

how to screen for esophageal varices?

Answer 19

EGD

Question 20

how to screen for HCC?

Answer 20

Serial ultrasound

Question 21

how to screen for Hepatic encephalopathy?

Answer 21

More detailed neuro exam & testing

Question 22

What score on the CAGE score defines probable alcohol abuse?

Answer 22

yes to 2 or more of the questions

Question 23

How do you measure ascites?

Answer 23

Should measure waist circumference and weight to monitor ascites

Question 24

How do you treat COPD

Answer 24

Tiotropium (Spiriva) & a short-acting rescue inhaler

Question 25

What is HBsAg?

Answer 25

Hepatitis B surface antigen (HBsAg) is a blood test ordered to determine if someone is infected with the hepatitis B virus. If it is found, along with specific antibodies, it means the person has a hepatitis B infection.

Question 26

What is anti-HBc?

Answer 26

Appears at the onset of symptoms in acute hepatitis B and persists for life. The presence of anti-HBc indicates previous or ongoing infection with hepatitis B virus in an undefined time frame.

Question 27

What is anti-Hbs?

Answer 27

``` The presence of anti-HBs is generally interpreted as indicating recovery and immunity from hepatitis B virus infection. Anti-HBs also develops in a person who has been successfully vaccinated against hepatitis B. ```

Question 28

What is (IgM anti-HBc)?

Answer 28

Positivity indicates recent infection with hepatitis B virus (<6 mos). Its presence indicates acute infection.

Question 29

What is the interpretation of this: HBsAg: neg anti-HBc: neg anti-HBs: neg

Answer 29

susceptible

Question 30

What is the interpretation of this: HBsAg: neg anti-HBc: pos anti-HBs: pos

Answer 30

immune due to natural infection

Question 31

What is the interpretation of this: HBsAg: neg anti-HBc: neg anti-HBs: pos

Answer 31

Immune due to Hep B vaccination

Question 32

``` What is the interpretation of this: this: HBsAg: pos anti-HBc: pos anti-HBs: pos IgM anti-Hbc: neg ```

Answer 32

acute and active

Question 33

``` What is the interpretation of this: this: HBsAg: pos anti-HBc: pos anti-HBs: neg IgM anti-Hbc: neg ```

Answer 33

chronically infected