Cirrhosis/ETOH Hepatitis

Question 1

What is the 4 most common etiologies of cirrhosis/ETOH hepatitis?

Answer 1

1. chronic viral hepatitis
2. alcoholic liver disease
3. hemochromatosis
4. NALFD

Question 2

What medications can result in Cirrhosis? (2)

Answer 2

• Methotrexate

- Isoniazid

Question 3

What is the pathophysiology of cirrhosis?

Answer 3

• fibrosis distorts hepatic architecture

- leads to functionally abnormal “regenerative” nodules

Question 4

What dermatologic manifestation is commonly seen in Cirrhosis?

Answer 4

• Terry nails

Question 5

What is the gold standard for diagnosing cirrhosis?

Answer 5

liver biopsy

Question 6

What are 2 complications of ascites secondary to cirrhosis?

Answer 6

• spontaneous bacterial peritonitis (SBP)

- hepatorenal syndrome (HRS)

Question 7

The root of most complications in cirrhosis is due to what?

Answer 7

• portal hypertension

Question 8

How do you measure the serum ascites albumin gradient (SAAB)?

What value suggests a liver source?

Answer 8

• SAAB = Alb (serum) - Alb (ascites)

- >1.1 g/dL = liver source

Question 9

How is hepatorenal syndrome diagnosed?

Answer 9

• diagnosis of exclusion

Question 10

What is the cause of hepatorenal syndrome?

Answer 10

• decreased renal perfusion leading to renal failure d/t liver disease

Question 11

What medication may be helpful in treating the muscle cramps secondary to cirrhosis?

Answer 11

quinine

Question 12

What is an adverse effect of surgically repairing a umbilical hernia?

Answer 12

flood syndrome

Question 13

What medications may be helpful to treat coagulopathy?

Answer 13

• FFP, Vitamin K

Question 14

What is the treatment of variceal bleeding? (5 step)

Answer 14

• ETT intubation*
• PPI
• somatostatin analog (Octreotide)
• EGD
• SBP prophylaxis

*comes first

Question 15

What is a Sengstaken-Blakemore tube used for?

Answer 15

• compress a variceal hemorrhage

Question 16

What medication is used to reduce portal hypertension by causing splanchnic arterial and portal venous system vasoconstriction?

Answer 16

• Nadolol or Propranolol (B-blockers)

Question 17

What is the treatment of ascites secondary to cirrhosis? (3)

Answer 17

• salt restriction (2 gm/day)
• diuretics (spironolactone)
• frequent paracentesis

*TIPS last resort

Question 18

What are the 2 main points to managing hepatorenal syndrome?

Answer 18

• avoid nephrotoxins

- consult renal

Question 19

What 2 medications combined is used in hepatorenal syndrome to raise BP?

Answer 19

• midodrine + octreotide

Question 20

What 2 medications are used in treatment of hepatic encephalopathy?

Answer 20

• lactulose = enhances ammonia excretion

- rifaximin = decreases Nh3 production

Question 21

What is the definitive treatment for decompensated cirrhosis?

Answer 21

• liver transplant

Question 22

What is the median survival for compensated cirrhosis?

Answer 22

> 12 years

Question 23

A MELD score of > 21 has a median survival rate of how long?

Answer 23

< 6 months

Question 24

What is the Child-Pugh score used for?

What are the 3 classes of the Child-Pugh score and what scores correlate to each?

Answer 24

• Class A = 5-6 = compensated
• Class B = 7-9 = decreased liver function, needs transplant
• Class C = 10-15 = no liver function

*estimates cirrhosis severity

Question 25

What AST/ALT ratio is consistent with alcoholic hepatitis?

Answer 25

AST:ALT > 2

Question 26

What are Mallory-Denk body formations and what is it characteristic of?

Answer 26

• eosinophillic hepatocytes that is characteristic of alcoholic hepatitis

Question 27

What is the difference in prognosis/treatment of alcoholic hepatitis depending if the Maddrey’s Discriminant Function (MDF) score is greater/less than 32?

Answer 27

• > 32 = higher mortality rate (25-35% in one month) = treat with prednisolone
• < 32 = lower mortality rate = supportive treatment

Question 28

In a patient with alcoholic hepatitis what is the improvement in 5 year survival if the patient stops drinking?

Answer 28

• from 32% to 75%