Complications of liver disease

Question 1

infectious Causes of Chronic or Cirrhotic Liver Disease

Answer 1

Viral hepatitis (hepatitis B–D, rarely E), 
Echinococcus infections, 
brucellosis, 
congenital tertiary syphilis, 
schistosomiasis

Question 2

Drugs and toxins of Chronic or Cirrhotic Liver Disease

Answer 2

Alcohol, methotrexate, isoniazid, vitamin A, amiodarone

Question 3

Risk factors for SBP

Answer 3

upper gastrointestinal hemorrhage,
ascitic fluid protein concentration less than 1 g/dL, and
a previous episode of SBP

Question 4

Diagnostic Criteria for Hepatorenal Syndrome

Answer 4

Cirrhosis with ascites
Serum creatinine >1.5 mg/dL
No improvement in serum creatinine (≤1.5 mg/dL) after 2+ days of diuretic withdrawal and volume expansion using 1 g/kg/day (up to 100 g/day of intravenous albumin)
Absence of shock
No current or recent exposure to nephrotoxic agents
No proteinuria >500 mg/day, microhematuria >50 RBC/hpf, or abnormal renal ultrasonography

Question 5

Precipitating Factors for the Development of Hepatic Encephalopathy

Answer 5

(Bleeding and infection most common)
Azotemia
Constipation
Dehydration
Drugs (benzodiazepines, narcotics, sedatives, diuretics)
Electrolyte and acid-base derangements (hypokalemia, hyponatremia, alkalosis)
Gastrointestinal bleeding
Infection
Liver-related (acute hepatitis, progression of chronic disease, portosystemic shunts, portal vein thrombosis)
Malnutrition

Question 6

Indications for liver transplantation

Answer 6

Acute liver failure
Decompensated cirrhosis
Inherited metabolic disorders with debilitating extrahepatic features
HCC using strict selection guidelines (Milan criteria)
Polycystic disease
Budd-Chiari syndrome (hepatic vein thrombosis)

Question 7

Absolute Contraindications for liver transplantation

Answer 7

Active extrahepatic malignancy (except neuroendocrine tumors)
Unstable cardiopulmonary disease
Uncontrolled sepsis
Severe, irreversible neurologic disease
AIDSSevere psychological or social dysfunction

Question 8

Relative Contraindications for liver transplantation

Answer 8

Ongoing alcohol or illicit substance abuse
Untreated HIVBMI >40 or <18.5 kg/m2
Age >70 years
Advanced renal disease (requires combined liver/kidney transplantation)
Portal vein thrombosis

Question 9

Nonmalignant conditions that are more common in posttransplant patients include

Answer 9

hypertension, diabetes, hyperlipidemia, obesity, renal disease, and osteoporosis.

Question 10

malignant conditions that are more common in posttransplant patients include

Answer 10

both skin cancers and solid tumors

Question 11

Rx of Acute variceal hemorrhage

Answer 11

treated with hemodynamic resuscitation, intravenous octreotide, and antibiotics followed by endoscopic band ligation or sclerotherapy

Question 12

β-Blockers in variceal bleeding

Answer 12

have been shown to prevent bleeding in patients with known varices but have no role in the management of an acute variceal bleed.

Question 13

HCC diagnosis

Answer 13

enhancing mass on ultrasonographywith and AFP of greater than 400 is diagnostic. Metastatic lesions to the liver would not cause this degree of AFP elevation.