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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
Lab test results in spontaneous bacterial peritonitis
- Ascitic fluid will appear turbid (not clear) because of pus - Leukocytosis (granulocytes) - Gram stain and culture will confirm diagnosis
26
Hepatic venous *outflow* tract obstruction condition
Budd-Chiari syndrome
27
Symptoms of hepatorenal syndrome
- Deep jaundice - Moribund - Tense ascites
28
Reason for skin/eye pigment, hormonal, CNS, and other changes to the body in liver cirrhosis patients
Things build up in the body when liver isn't working and causes many multisystem symptoms
29
Wilson's disease treatments
- 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
30
Differences between primary *biliary* cholangitis and primary *sclerosing* cholangitis
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
Body's response to hypovolemia in portal hypertension which ends up making everything worse
Increased RAAS and sympathetic nervous system activation
32
Most common causes (3) of liver cirrhosis in the US
Non-alcoholic fatty liver (NASH) Excessive alcohol intake Chronic hepatitis C
33
Physical exam tests for ascites
Shifting dullness or fluid wave (not very accurate, confirm with ultrasound)
34
Diagnostic method needed to establish liver cirrhosis diagnosis
Liver biopsy
35
Describe Cruveilhier-Baumgarten murmur
Not heard from the heart, more like a bruit Noisy blood in the abdomen in cirrhosis patients with ascites
36
Common cause of Budd-Chiari syndrome
Hypercoagulable state - blood clot blocks hepatic *outflow*
37
Specific treatment medications (3) for primary biliary cholangitis
Ursodiol - helps pass bile through damaged ducts Colchicine and methotrexate can improve liver function
38
Inheritance pattern of a1-antitrypsin deficiency
Autosomal (co)dominant
39
If cirrhosis develops in a patient with hemochromatosis they have a 200x risk of developing this disease
Hepatocellular carcinoma
40
Inheritance pattern of hereditary hemochromatosis
Autosomal recessive
41
Elevated concentrations of blood ammonia in a patient with cirrhosis suggest this complication
Hepatic encephalopathy
42
Diagnostic tests in hereditary hemochromatosis
- Iron and iron protein serum tests - HFE gene testing - Liver biopsy
43
Primary biliary cholangitis is most common in this gender and age group
Women aged 30-50
44
Element that builds up in liver and brain of patients with Wilson's disease
Copper
45
Describe caput medusae
Scarred liver -> portal HTN -> blood backs up -> ascites and very distended veins over abdomen
46
Acute syndrome symptoms (5) of alcoholic cirrhosis
- Fever - RUQ tenderness - Enlarged liver - Jaundice - Leukocytosis
47
Most common risk factor for NAFLD and NASH
Metabolic syndrome (3 or more of the following: high waist circumference, hypertriglyceridemia, HTN, high fasting glucose, low HDL)
48
Treatments for Budd-Chiari syndrome
- Anticoagulation - Treat underlying hypercoagulability/portal HTN - TIPS procedure
49
Abnormal lab values (2) in Wilson's disease
Depression or absence of serum ceruloplasmin Increased urinary copper levels
50
A patient with RUQ pain and a known hypercoagulable state may have developed this condition
Budd-Chiari syndrome
51
Components of the Child-Pugh score and how they change with more severe liver cirrhosis
- Bilirubin: increases - Serum albumin: decreases - PT INR: increases - Ascites: increases - Hepatic encephalopathy: increases
52
Describe cirrhosis of the liver
A late stage of progressive hepatic fibrosis, characterized by a distortion of hepatic architecture and the formation of regenerative nodules
53
If a liver cirrhosis patient has ascites limit sodium to this amount daily
2000 mg/day
54
Lab findings in liver cirrhosis diagnosis
Decreased serum albumin level and a prolonged prothrombin time are characteristic Elevated AST>ALT and ALP levels
55
Hereditary hemochromatosis is more common in patients with ancestors from this geographical region
Europe
56
Diagnosis of NAFLD and NASH requires this in the absence of significant alcohol use or other liver conditions
Demonstration of fatty liver on imaging or biopsy Will show degree of fibrosis
57
Glucocorticoid treatment is only useful in this liver cirrhosis patient subgroup
Only useful in patients with severe alcoholic hepatitis *and* hepatic encephalopathy
58
Medications (3) for NAFLD and NASH
- Vitamin E - Metformin - Pioglitazone
59
Which is more serious and further progressed condition, NAFL or NASH?
NASH NAFL = fat in liver NASH = inflammation from fat in liver
60
Procedure treatments (3) for ascites
- Paracentesis (diagnosis and treatment) - Give IV albumin - Peritoneovenous shunt if no response to meds
61
Symptoms of decompensated liver cirrhosis
Decompensated: - Jaundice - Pruritus - GI bleeding (esophageal varices) - Ascites - Confusion - Muscle cramps
62
Two chief complaints (symptoms) of a patient with primary biliary cholangitis
Fatigue Generalized pruritus (itching)
63
Score used in assessing severity of liver cirrhosis
Child-Pugh score
64
Testicular cancer marker that's also used in bi-annual tracking of liver cirrhosis patients (along with an abdominal ultrasound)
a-fetoprotein
65
A young person without a long history of smoking presents with COPD-like symptoms and liver dysfunction. What condition might cause this?
a1-antitrypsin deficiency
66
Procedure for draining ascitic fluid
Paracentesis
67
Treatments for variceal bleeding
- Endoscopic band ligation - Antibiotic prophylaxis - Vasoactive drugs (octreotide)
68
Four elevated lab values in primary biliary cholangitis
- Antimitochondrial antibodies (AMA) - ALP - IgM - Serum cholesterol
69
Is ERCP used in primary *biliary* cholangitis, primary *sclerosing* cholangitis, or both?
Only in PSC No use in PBC, can't reach intra-hepatic ducts
70
Spontaneous bacterial peritonitis often develops in advanced cirrhosis and can cause injury to this organ
Kidneys
71
Vitamins/minerals (3) supplemented in the management of liver cirrhosis patients
Zinc Calcium VItamin D
72
Medications (2) for ascites
- Spironolactone - Add furosemide if needed
73
Condition associated with low or absent serum ceruloplasmin
Wilson's disease

Clin Med 1 - Exam 5 (13 decks)

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