cirrhosis, hypertension, complkications

Question 1

3 general complications of cirrhosis

Answer 1

1. portal HT
2. encephalopathy
3. hepato cellular CA

Question 2

3 def. of cirrhosis

Answer 2

1/ presence throughout liver of fibrous septa that subdivide into nodules

2. accum. throughout the liver of confluent extinction area
3. collection of anatomic changes in the liver that result from the widespread imbalance of hepatic blood flow

Question 3

3 most common causes of cirrhosis

Answer 3

1. hep C
2. hep B
3. fatty liver

Question 4

2 less common causes

Answer 4

1. autoimmune

2. inherited metabolic diseases

Question 5

dynamic process that is fibrosis

Answer 5

1. begins with insult to parenchyma
2. fibrosis expands to form septa which surround nodules
3. diff. etiologies cause different patterns and have differetn rates of progression

Question 6

what are vasc. effects of cirrhosis

Answer 6

important features

- thrombosis, obliteration, re-canalizations of veins

Question 7

5 stages of fibrosis

Answer 7

0 - normal
1 - enlarged fibrotic portal tracts
2 - periportal and portaal-portal septa, but intact arch.
3. arch. distortions
4, def. cirrhosis

Question 8

9 full complications

Answer 8

AC 9H
Ascites
Coagulopathy
portal HT
Hypoalbumin
Hepatic encephalopathy
Hepatorenal
Hypoglycemia
Hyperbili
Hyper estrogen
HCC

Question 9

2 ways to diagnosw

Answer 9

1. HX - so Sx until late

2. physical - none until cirrhosis well established

Question 10

common physical findings

Answer 10

• dupetrens

- spider nevi

Question 11

signs of early cirrhosis

Answer 11

hypersplenism

Question 12

signs of late cirrhosis

Answer 12

synthesis failure - INR, albumin

exretion failure - bili

Question 13

tests for cirrhosis

Answer 13

1 imaging - US/CT/ MRI

2. liver biopsy
3. non invasive - fibroscan

Question 14

what are important levels of portal pressure

3

Answer 14

2-3 - normal
>6 - abnormal
>12 varices bleed

Question 15

2 times when variceal bleeds common

Answer 15

• pressure over 12

- valsalva

Question 16

3 levels of Na excretion and treatment

Answer 16

mild - 5g/d - diet
mod - 2-3 - add diuretics
severe - 1-2 - paracentesis

Question 17

def HE

Answer 17

delerium in the setting of liver failure

Question 18

possible causes of HE

Answer 18

not really known - toxins?

Question 19

treatment of HE

Answer 19

• ID cause and treat - infection

- additional mgmt with lactulose - for ammonia

Question 20

def. of hepatocellular carcinoma

Answer 20

hepatoma

- primary malignant neoplasm of liver with hepatocytic diff.

Question 21

major risk for HCC

Answer 21

cirrhoisis

Question 22

mgmt of HCC

Answer 22

often very large at presentation

Question 23

CT diagnosis of HCC

Answer 23

• doesn’t need biopsy
• arterial phase - hepatoma bright
• venous phase - hepatoma is darker

Question 24

HCC morpho

Answer 24

encapsulated tumor mass with focal necrosis

Question 25

2 scales to assess severity

Answer 25

CPT and MELD

Question 26

CPT contents

Answer 26

INR

• Albumin
• bili
• ascites
• HE

Question 27

3 features of MELD

Answer 27

• bili
• creat
• INR