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Clin Med 1 - Exam 5 > Cirrhosis and Portal Hypertension > Flashcards

Cirrhosis and Portal Hypertension Flashcards

1
Q

Category of drugs to avoid in liver cirrhosis patients

A

NSAIDs

(Lowers venous return > lowers CO > lowers kidneys blood supply)

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2
Q

Ultrasound method used in the diagnosis of liver cirrhosis

A

Elastography

(how much can the tissue compress)

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3
Q

Imaging used to confirm ascites diagnosis

A

Ultrasound

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4
Q

Symptoms (3) of hepatic encephalopathy

A
  • Mental obtundation
  • Asterixis
  • Fetor hepaticus (breath of the dead)

(basically decompensated cirrhosis plus confusion)

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5
Q

Initial treatments (2) of ascites

A
  • Discontinue any drugs that inhibit prostaglandin (aspirin, NSAIDs)
  • Restrict sodium and water intake
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6
Q

Three elevated lab values in hereditary hemochromatosis

A
  • Transferrin saturation (but transferrin total is low, not needed with so much iron in body)
  • Ferritin
  • Serum iron
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7
Q

Inheritance pattern of Wilson’s disease

A

Autosomal recessive

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8
Q

Diuretics to use in management of a patient with liver cirrhosis

A

Spironolactone with furosemide

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9
Q

Explain how to differentiate between hydrostatic and osmotic causes of ascites

A
  • Draw fluid with paracentesis
  • Use SAAG to see how much protein is in the fluid:
    Serum protein > ascitic protein = hydrostatic (portal HTN pushing fluid out)
    Ascitic protein > serum protein = osmotic (nephrotic sign)
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10
Q

Describe cause of spontaneous bacterial peritonitis

A

Bacterial infection (pus) in ascitic fluid

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11
Q

Non-specific treatments (4) for primary biliary cholangitis

A

Cholestyramine, rifampin, UV light to help pruritus (itchiness)

Fat-soluble vitamin supplementation

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12
Q

Physical exam signs of cirrhosis

A
  • Jaundice
  • Palmar erythema
  • Spider nevi/angiomata/telangiectasias
  • Gynecomastia
  • Dupuytren (ring finger) contracture
  • Kayser-Fleischer rings (copper)
  • Bronze skin discoloration (iron)
  • Hepatomegaly with firm, nodular, palpable liver
  • Splenomegaly
  • Caput medusae
  • Cruvehilhier-Baumgarten murmur
  • Nail changes
  • Asterixis
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13
Q

The only established treatment therapy for alcoholic cirrhosis is

A

Cessation of alcohol intake

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14
Q

Symptoms of compensated liver cirrhosis

A

Compensated:
- Anorexia
- Weight loss
- Weakness
- Fatigue

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15
Q

Primary biliary cholangitis pathophysiology

A

Antimitochondrial autoantibodies (AMA) destroy intrahepatic bile ducts

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16
Q

Five signs of hepatorenal syndrome

A
  • Hypoalbuminemia
  • Hypothrombinemia
  • Encephalopathy
  • Low urine and sodium excretion
  • High serum BUN and creatinine
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17
Q

Signs and symptoms of Wilson’s disease are similar to other cirrhosis except for these differences

A

Neurologic symptoms and Kayser-Fleischer rings in the peripheral cornea

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18
Q

Most common symptoms (3) of NAFLD and NASH

A
  • Fatigue
  • Weakness
  • Malaise
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19
Q

Classic tetrad of symptoms in hereditary hemochromatosis

A
  • Liver disease
  • Diabetes
  • Skin pigmentation (bronzing)
  • Gonadal failure
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20
Q

Hemochromatosis treatment

A

Regular phlebotomy

(ideally start before diabetes/cirrhosis develops)

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21
Q

The first step in the progression from compensated to decompensated liver cirrhosis

A

Portal hypertension

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22
Q

At time of liver cirrhosis diagnosis, check for these two co-occurring conditions

A

Serology for hepatitis

Endoscopy for esophageal varices

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23
Q

Medication for hepatic encephalopathy

A

Lactulose

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24
Q

What is SAAG?

A

Serum ascites albumin gradient

Used to differentiate hydrostatic from osmotic causes of ascites

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25
Q

Lab test results in spontaneous bacterial peritonitis

A
  • Ascitic fluid will appear turbid (not clear) because of pus
  • Leukocytosis (granulocytes)
  • Gram stain and culture will confirm diagnosis
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26
Q

Hepatic venous outflow tract obstruction condition

A

Budd-Chiari syndrome

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27
Q

Symptoms of hepatorenal syndrome

A
  • Deep jaundice
  • Moribund
  • Tense ascites
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28
Q

Reason for skin/eye pigment, hormonal, CNS, and other changes to the body in liver cirrhosis patients

A

Things build up in the body when liver isn’t working and causes many multisystem symptoms

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29
Q

Wilson’s disease treatments

A
  • Restrict dietary copper (shellfish, organ meats, nuts etc)
  • Hep A, Hep B vaccines
  • Avoid heavy alcohol use
  • D-penicillamine binds copper and promotes urinary excretion
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30
Q

Differences between primary biliary cholangitis and primary sclerosing cholangitis

A

Both have pruritus and fatigue

PBC:
- Mostly young to middle-aged women
- Only ducts in liver involved
- Presence of anti-mitochondrial antibodies (AMA)

PSC:
- Mostly young to middle-aged men
- Whole biliary tree involved (liver and gallbladder)

31
Q

Body’s response to hypovolemia in portal hypertension which ends up making everything worse

A

Increased RAAS and sympathetic nervous system activation

32
Q

Most common causes (3) of liver cirrhosis in the US

A

Non-alcoholic fatty liver (NASH)

Excessive alcohol intake

Chronic hepatitis C

33
Q

Physical exam tests for ascites

A

Shifting dullness or fluid wave

(not very accurate, confirm with ultrasound)

34
Q

Diagnostic method needed to establish liver cirrhosis diagnosis

A

Liver biopsy

35
Q

Describe Cruveilhier-Baumgarten murmur

A

Not heard from the heart, more like a bruit

Noisy blood in the abdomen in cirrhosis patients with ascites

36
Q

Common cause of Budd-Chiari syndrome

A

Hypercoagulable state - blood clot blocks hepatic outflow

37
Q

Specific treatment medications (3) for primary biliary cholangitis

A

Ursodiol - helps pass bile through damaged ducts

Colchicine and methotrexate can improve liver function

38
Q

Inheritance pattern of a1-antitrypsin deficiency

A

Autosomal (co)dominant

39
Q

If cirrhosis develops in a patient with hemochromatosis they have a 200x risk of developing this disease

A

Hepatocellular carcinoma

40
Q

Inheritance pattern of hereditary hemochromatosis

A

Autosomal recessive

41
Q

Elevated concentrations of blood ammonia in a patient with cirrhosis suggest this complication

A

Hepatic encephalopathy

42
Q

Diagnostic tests in hereditary hemochromatosis

A
  • Iron and iron protein serum tests
  • HFE gene testing
  • Liver biopsy
43
Q

Primary biliary cholangitis is most common in this gender and age group

A

Women aged 30-50

44
Q

Element that builds up in liver and brain of patients with Wilson’s disease

A

Copper

45
Q

Describe caput medusae

A

Scarred liver -> portal HTN -> blood backs up -> ascites and very distended veins over abdomen

46
Q

Acute syndrome symptoms (5) of alcoholic cirrhosis

A
  • Fever
  • RUQ tenderness
  • Enlarged liver
  • Jaundice
  • Leukocytosis
47
Q

Most common risk factor for NAFLD and NASH

A

Metabolic syndrome

(3 or more of the following: high waist circumference, hypertriglyceridemia, HTN, high fasting glucose, low HDL)

48
Q

Treatments for Budd-Chiari syndrome

A
  • Anticoagulation
  • Treat underlying hypercoagulability/portal HTN
  • TIPS procedure
49
Q

Abnormal lab values (2) in Wilson’s disease

A

Depression or absence of serum ceruloplasmin

Increased urinary copper levels

50
Q

A patient with RUQ pain and a known hypercoagulable state may have developed this condition

A

Budd-Chiari syndrome

51
Q

Components of the Child-Pugh score and how they change with more severe liver cirrhosis

A
  • Bilirubin: increases
  • Serum albumin: decreases
  • PT INR: increases
  • Ascites: increases
  • Hepatic encephalopathy: increases
52
Q

Describe cirrhosis of the liver

A

A late stage of progressive hepatic fibrosis, characterized by a distortion of hepatic architecture and the formation of regenerative nodules

53
Q

If a liver cirrhosis patient has ascites limit sodium to this amount daily

A

2000 mg/day

54
Q

Lab findings in liver cirrhosis diagnosis

A

Decreased serum albumin level and a prolonged prothrombin time are characteristic

Elevated AST>ALT and ALP levels

55
Q

Hereditary hemochromatosis is more common in patients with ancestors from this geographical region

A

Europe

56
Q

Diagnosis of NAFLD and NASH requires this in the absence of significant alcohol use or other liver conditions

A

Demonstration of fatty liver on imaging or biopsy

Will show degree of fibrosis

57
Q

Glucocorticoid treatment is only useful in this liver cirrhosis patient subgroup

A

Only useful in patients with severe alcoholic hepatitis and hepatic encephalopathy

58
Q

Medications (3) for NAFLD and NASH

A
  • Vitamin E
  • Metformin
  • Pioglitazone
59
Q

Which is more serious and further progressed condition, NAFL or NASH?

A

NASH

NAFL = fat in liver
NASH = inflammation from fat in liver

60
Q

Procedure treatments (3) for ascites

A
  • Paracentesis (diagnosis and treatment)
  • Give IV albumin
  • Peritoneovenous shunt if no response to meds
61
Q

Symptoms of decompensated liver cirrhosis

A

Decompensated:
- Jaundice
- Pruritus
- GI bleeding (esophageal varices)
- Ascites
- Confusion
- Muscle cramps

62
Q

Two chief complaints (symptoms) of a patient with primary biliary cholangitis

A

Fatigue

Generalized pruritus (itching)

63
Q

Score used in assessing severity of liver cirrhosis

A

Child-Pugh score

64
Q

Testicular cancer marker that’s also used in bi-annual tracking of liver cirrhosis patients (along with an abdominal ultrasound)

A

a-fetoprotein

65
Q

A young person without a long history of smoking presents with COPD-like symptoms and liver dysfunction. What condition might cause this?

A

a1-antitrypsin deficiency

66
Q

Procedure for draining ascitic fluid

A

Paracentesis

67
Q

Treatments for variceal bleeding

A
  • Endoscopic band ligation
  • Antibiotic prophylaxis
  • Vasoactive drugs (octreotide)
68
Q

Four elevated lab values in primary biliary cholangitis

A
  • Antimitochondrial antibodies (AMA)
  • ALP
  • IgM
  • Serum cholesterol
69
Q

Is ERCP used in primary biliary cholangitis, primary sclerosing cholangitis, or both?

A

Only in PSC

No use in PBC, can’t reach intra-hepatic ducts

70
Q

Spontaneous bacterial peritonitis often develops in advanced cirrhosis and can cause injury to this organ

A

Kidneys

71
Q

Vitamins/minerals (3) supplemented in the management of liver cirrhosis patients

A

Zinc

Calcium

VItamin D

72
Q

Medications (2) for ascites

A
  • Spironolactone
  • Add furosemide if needed
73
Q

Condition associated with low or absent serum ceruloplasmin

A

Wilson’s disease

Clin Med 1 - Exam 5 (13 decks)

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