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GBA - Y4 > Harrison's 337- Cirrhosis & It's Complications > Flashcards

Harrison's 337- Cirrhosis & It's Complications Flashcards

1
Q

What is the pathological role of stellate cells in the development of cirrhosis?

A

Production of Collagen - Fibrosis

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2
Q

Apart from the precursor stage of Fibrosis, What are the other gross features that arise in liver Cirrhosis? (3)

A

Nodule Formation
Functional & Size Decline
Blood flow Stagnation

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3
Q

Cutaneous manifestations of cirrhosis include :

A 
Jaundice
Spider angiomata
Skin telangiectasias ("paper money skin")
Palmar erythema
Clubbing
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4
Q

Hematological manifestations of cirrhosis include :

A

Bleeding Tendency (PTT↑, VitK loss)
Hypoalbuminemia
Hyperammonemia

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5
Q

Vascular manifestations of cirrhosis include :

A

Portal Hypertension
Ascites
Portacaval Anastomosis
Pedal Edema, Pleural Effusion

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6
Q

What are the 3 enzyme systems that are involved in ethanol metabolism in the liver?

A

ADH-ALDH
MEOS (Microsomal ethanol oxidizing system)
Peroxisomal Catalase

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7
Q

What is the missing step:

Ethanol Metabolised by ADH → _______ → Kupffer Cell Release TNF → Activation of Stellate Cells → Fibrosis

A

What is the missing step:

Ethanol Metabolised by ADH→ Acetaldehyde→ Kupffer Cell Release TNF→Activation of Stellate Cells→Fibrosis

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8
Q

What is the missing step:

Ethanol Metabolised by ADH→ Acetaldehyde→ _____ Cell Release TNF→Activation of Stellate Cells→Fibrosis

A

What is the missing step:

Ethanol Metabolised by ADH→ Acetaldehyde→ Kupffer Cell Release TNF→Activation of Stellate Cells→Fibrosis

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9
Q

What is the missing step:

Ethanol Metabolised by ADH→ Acetaldehyde→ Kupffer Cell Release TNF→Activation of ____ Cells→Fibrosis

A

What is the missing step:

Ethanol Metabolised by ADH→ Acetaldehyde→ Kupffer Cell Release TNF→Activation of Stellate Cells→Fibrosis

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10
Q

Fibrosis of the liver usually takes -

A

10 years

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11
Q

How does these values change with Ethanol consumption:
TGA (ICM)
Beta-Oxidation
Lipoprotein Secretion

A

How does these values change with Ethanol consumption:
TGA (ICM)↑
Beta-Oxidation↓
Lipoprotein Secretion↓

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12
Q

What are the clinical signs & symptoms unique to ALD Cirrhosis?

A

Parotid Gland Enlargement

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13
Q

What are the diagnostic measures for ALD Cirrhosis?

A

Fibroscan

Liver Biopsy after 6 months of withdrawal

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14
Q

What supplemental treatment is possible for ALD Cirrhosis?

A

Acamprosate Calcium

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15
Q

What are the anti-inflammatory agents used in ALD Cirrhosis?

A

Glucocorticoids

Pentoxifylline

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16
Q

HCV can lead to 80% of pateints developing Chronic hepatitis that leads to __% of them having Cirrhosis (some ALD related)

A

HCV can lead to 80% of pateints developing Chronic hepatitis that leads to 30% of them having Cirrhosis (some ALD related)

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17
Q

ALD , Hemochromatosis, Hepatic Venous outflow obstruction, Chronic biliary obstruction, Jejunoileal Bypass, and Indian childhood cirrhosis all cause __________ type of Cirrhosis!

A

ALD , Hemochromatosis, Hepatic Venous outflow obstruction, Chronic biliary obstruction, Jejunoileal Bypass, and Indian childhood cirrhosis all cause Micronodular type of Cirrhosis! (3mm>)

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18
Q

Viral hepatitis (HBV or HCV), Wilson’s disease, alpha-1-antitrypsin deficiency, Late Stage ALD Cirrhosis, Hepatotoxic Drugs & Toxins all cause __________ type of Cirrhosis!

A

Viral hepatitis (HBV or HCV), Wilson’s disease, alpha-1-antitrypsin deficiency, Late Stage ALD Cirrhosis, Hepatotoxic Drugs & Toxins all cause Macronodular type of Cirrhosis! (3mm

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19
Q

HBV can lead to 5% of pateints developing Chronic hepatitis that leads to __% of them having Cirrhosis

A

HBV can lead to 5% of pateints developing Chronic hepatitis that leads to 20% of them having Cirrhosis

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20
Q

HBV Cirrhosis Hepatocyte will appear

A

Finely granular, Highly Eosinophilic, Ground-Glass Appearance Hepatoctes

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21
Q

In Cirrhotic HBV the treatment of Choice is :

A

Entecavir Monotherapy

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22
Q

In Cirrhotic HCV the treatment of Choice is :

A

Ledipasvir & Sofosbuvir

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23
Q

What are the autoimmune markers for AIH?

as a cause of Cirrhosis

A

ASMA

ANA

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24
Q

What is the epidemiological trend regarding NAFLD?

A

RISING WITH OBESITY

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25
Median Age and Common Gender of PBC?
50 years old, Female
26
What is the recommended treatment of PBC with Uncompensated Cirrhosis?
Liver Transplant + UDCA (lowers progression)
27
In 90% of PBC patients we will see in lab test the ___ Antigen.
In 90% of PBC patients we will see in lab test the AMA Antigen.
28
PBC is a progressive cholestatic disease characterized by destruction of (Intra/Extra)hepatic bile ducts, periportal inflammation and fibrosis.
PBC is a progressive cholestatic disease characterized by destruction of Intrahepatic bile ducts, periportal inflammation and fibrosis.
29
What are the clinical signs & symptoms unique to PBC Cirrhosis?
Severe Fatigue Itchy skin Xanthomata/Xanthoma Osteopenia
30
Apart from AMA detection, what else are important criteria for diagnosis of PBC? (other 10% of non-AMA PBC Patients)
- Cholangiography to rule out PSC | - Liver Biopsy
31
Primary sclerosing cholangitis (PSC) is a chronic liver disease caused by progressive inflammation and periductal scarring of the (Intra/Extra)hepatic bile ducts.
Primary sclerosing cholangitis (PSC) is a chronic liver disease caused by progressive inflammation and scarring of the Intra- and Extrahepatic bile ducts.
32
In 65% of PSC patients we will see in lab test the ______ Antigen.
In 65% of PSC patients we will see in lab test the p-ANCA Antigen.
33
In 50% of PSC patients we will also see __ this is why the diagnosis indicates a following colonoscopy as well.
In 50% of PSC patients we will also see UC this is why the diagnosis indicates a following colonoscopy as well.
34
What is the leading cholangiographic signs of ERCP/MRCP in PSC?
Beads on a string pattern
35
HVPG > 5 mmHg | What is the treatment why?
Propranolol | Portal Hypertension
36
HVPG > 12 mmHg | What is the treatment why?
TIPS than Liver Transplant | High Probability of Varices Rupture
37
SAAG >1.1 mg/dL + Ascites Protein>2.5 g/dL=
CHF
38
SAAG >1.1 mg/dL + Ascites Protein<2.5 g/dL =
Liver Cirrhosis
39
What are the possible Intrahepatic Etiologies Portal Hypertension apart from Cirrhosis?
Schistosoma Mansoni | Veno-occlusive Disease (high doses of chemotherapy and radiation therapy)
40
apart from HVPG > 12 mmHg | What other signs are related to High Probability of Varices Rupture?
High Child Score High MELD Score Size and Location of Varices Endoscopic Signs
41
Massive bleeding Varices management steps: 1) ______________________________________ 2) Vasopressors - Somatostatins/Terlipressin 3) Massive blood transfusion ( 6 dose) 4) Emergency Endoscopy
Massive bleeding Varices management steps: 1) Airway, Breathing, Circulation - Ringer Lactate 2) Vasopressors - Somatostatins/Terlipressin 3) Massive blood transfusion ( 6 dose) 4) Emergency Endoscopy
42
Massive bleeding Varices management steps: 1) Airway, Breathing, Circulation - Ringer Lactate 2) ____________________________ 3) Massive blood transfusion ( 6 dose) 4) Emergency Endoscopy
Massive bleeding Varices management steps: 1) Airway, Breathing, Circulation - Ringer Lactate 2) Vasopressors - Somatostatins/Terlipressin 3) Massive blood transfusion ( 6 dose) 4) Emergency Endoscopy
43
Massive bleeding Varices management steps: 1) Airway, Breathing, Circulation - Ringer Lactate 2) Vasopressors - Somatostatins/Terlipressin 3) ____________________________ 4) Emergency Endoscopy
Massive bleeding Varices management steps: 1) Airway, Breathing, Circulation - Ringer Lactate 2) Vasopressors - Somatostatins/Terlipressin 3) Massive blood transfusion ( 6 dose) 4) Emergency Endoscopy
44
Massive bleeding Varices management steps: 1) Airway, Breathing, Circulation - Ringer Lactate 2) Vasopressors - Somatostatins/Terlipressin 3) Massive blood transfusion ( 6 dose) 4) ____________________________
Massive bleeding Varices management steps: 1) Airway, Breathing, Circulation - Ringer Lactate 2) Vasopressors - Somatostatins/Terlipressin 3) Massive blood transfusion ( 6 dose) 4) Emergency Endoscopy
45
Emergency Endoscopy for Massive bleeding Varices management: | what is the most important treatment option here?
Single black mor tube - 250cc, inflated in gastric lumen to prevent esophageal bleeding
46
What is TIPS ? | What is the side effect?
Transjugular Intrahepatic Portocaval shunt, Hepatic Encephalopathy is the s.e.
47
For Procedural Prevention of Varices bleeding: What is the superior treatment Banding/Sclerotherapy?
Banding
48
In Cirrhosis after Varices bleeding - Transfusion should have?
FFP + Prothrombin Complex Concentrate (PCC = all factors, except 8)
49
Hepatorenal Syndrome - Laboratory Signs?
Creatinine > 3 mg/dL Na Urine > 10 mEq (Like prerenal azotemia)
50
What is the Dietary treatment for Ascites in a state of Cirrhosis?
Sodium Restriction
51
What is the Volume treatment for Ascites in a state of Cirrhosis?
Fusid & Spironolactone | Drainage/TIPS/Albumin Infusions
52
What is the Vascular treatment for Ascites in a state of Cirrhosis?
Midodrine (Alpha-1 Antagonist) Clonidine (Alpha-2 Agonist) *Both cause Splanchnic Vasoconstriction
53
What complication of Cirrhosis will cause LUQ pain, Thrombocytopenia and Leukopenia?
Hypersplenism and Splenomegaly
54
What is the diagnosis for SBP?
Leukocytes in Ascites Fluid>250 units/microL
55
What is the will indicate Peritoneal Dialysis causing for SBP?
Leukocytes in Ascites Fluid>100 units/microL
56
Tx for SBP?
Cefotaxime (for E.coli most common bug)
57
What are the possible treatment options for Hepatorenal Syndrome ?
Octreotide / Midodrine Albumin IV Liver Transplant
58
Hepatic Encephalopathy - Pathognomonic Signs
Cirrhotic Patient with Asterixis
59
What is the treatment for Hepatic Encephalopathy?
Hydration & Electrolytes | Lactulose & Rifaximin
60
What are the factors in CHILD Score?
``` Serum Bilirubin Serum Albumin PT Ascites level Hepatic Encephalopathy level ```
61
What are the factors in MELD Score?
Serum Bilirubin INR Creatinine Level (ALD + Cholestatic) / (Other Liver Diseases)
62
Elevation in Blood pressure after standing up is called? Part of What syndrome?
Orthostatic Hypertension | Hepatopulmonary Syndrome in Cirrhosis
63
alcoholic hepatitis or cirrhosis, hemolytic anemia, and hyperlipidemia =
Zieve's Syndrome
64
What are the types of Presinusoidal causes of Cirrhosis?
Congenital Hepatic Failure | Schistosomiasis
65
What are the types of Postsinusoidal causes of Cirrhosis?
VOD
66
HRS 1 Vs HRS 2 | What is the main Difference?
HRS 1 - ACUTE | HRS 2 - CHRONIC
67
What is the change in definition when 2 microbes are found in SBP?
("Complete") Peritonitis = 3 Types of Antibiotics
68
Treatment of Osmotic High ICP in Cirrhosis?
Hypertonic Solution Carefully administered Mannitol 45 Degrees Bed
69
Changes in Hemochromatosis in | Ferritin & Transferrin Saturation
Changes in Hemochromatosis in | Ferritin↑ & Transferrin Saturation↑
70
modified Maddrey's discriminant function involves?
Bilirubin level, aPT & Control difference
71
modified Maddrey's discriminant function less than 32 indicates use of -
Glucocorticoids or Pentoxifylline in Cirrhosis
72
Where does ALT is found in an hepatocyte? What does it tells us about pathogenesis of liver diseases?
Cytosolic Enzyme | Viral or Other Intracellular Infection is most probable
73
Where does AST is found in an hepatocyte? What does it tells us about pathogenesis of liver diseases?
Mitochondrial Enzyme | Oxidative process is most probable
74
``` Sedatives/Narcotics Hypovolemia Hypokalemia SBP TIPS Upper Esophageal Bleeding ``` Factors Predisposing to _____ __________ in Cirrhotic Patients
``` Sedatives/Narcotics Hypovolemia Hypokalemia SBP TIPS Upper Esophageal Bleeding ``` Factors Predisposing to Hepatic Encephalopathy in Cirrhotic Patients
75
What is the cause of Osteopenia & Osteoporosis in Cirrhosis?
Interference of cholestasis with vitamin D metabolism.
76
Gynecomastia Testicular Atrophy Spider Angiomas Palmar Erythema Cirrhosis Symptoms caused by Elevation in _______
Gynecomastia Testicular Atrophy Spider Angiomas Palmar Erythema Cirrhosis Symptoms caused by Elevation in Estrogen
77
Why would there be overactivity of Plasmin in Cirrhosis?
Decreased alpha 2-Antiplasmin

GBA - Y4 (12 decks)

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