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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
Q

Median Age and Common Gender of PBC?

A

50 years old, Female

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26
Q

What is the recommended treatment of PBC with Uncompensated Cirrhosis?

A

Liver Transplant + UDCA (lowers progression)

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27
Q

In 90% of PBC patients we will see in lab test the ___ Antigen.

A

In 90% of PBC patients we will see in lab test the AMA Antigen.

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28
Q

PBC is a progressive cholestatic disease characterized by destruction of (Intra/Extra)hepatic bile ducts, periportal inflammation and fibrosis.

A

PBC is a progressive cholestatic disease characterized by destruction of Intrahepatic bile ducts, periportal inflammation and fibrosis.

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29
Q

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

A

Severe Fatigue
Itchy skin
Xanthomata/Xanthoma
Osteopenia

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30
Q

Apart from AMA detection, what else are important criteria for diagnosis of PBC? (other 10% of non-AMA PBC Patients)

A
  • Cholangiography to rule out PSC

- Liver Biopsy

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31
Q

Primary sclerosing cholangitis (PSC) is a chronic liver disease caused by progressive inflammation and periductal scarring of the (Intra/Extra)hepatic bile ducts.

A

Primary sclerosing cholangitis (PSC) is a chronic liver disease caused by progressive inflammation and scarring of the Intra- and Extrahepatic bile ducts.

32
Q

In 65% of PSC patients we will see in lab test the ______ Antigen.

A

In 65% of PSC patients we will see in lab test the p-ANCA Antigen.

33
Q

In 50% of PSC patients we will also see __ this is why the diagnosis indicates a following colonoscopy as well.

A

In 50% of PSC patients we will also see UC this is why the diagnosis indicates a following colonoscopy as well.

34
Q

What is the leading cholangiographic signs of ERCP/MRCP in PSC?

A

Beads on a string pattern

35
Q

HVPG > 5 mmHg

What is the treatment why?

A

Propranolol

Portal Hypertension

36
Q

HVPG > 12 mmHg

What is the treatment why?

A

TIPS than Liver Transplant

High Probability of Varices Rupture

37
Q

SAAG >1.1 mg/dL + Ascites Protein>2.5 g/dL=

A

CHF

38
Q

SAAG >1.1 mg/dL + Ascites Protein<2.5 g/dL =

A

Liver Cirrhosis

39
Q

What are the possible Intrahepatic Etiologies Portal Hypertension apart from Cirrhosis?

A

Schistosoma Mansoni

Veno-occlusive Disease (high doses of chemotherapy and radiation therapy)

40
Q

apart from HVPG > 12 mmHg

What other signs are related to High Probability of Varices Rupture?

A

High Child Score
High MELD Score
Size and Location of Varices
Endoscopic Signs

41
Q

Massive bleeding Varices management steps:

1) ______________________________________
2) Vasopressors - Somatostatins/Terlipressin
3) Massive blood transfusion ( 6 dose)
4) Emergency Endoscopy

A

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
Q

Massive bleeding Varices management steps:

1) Airway, Breathing, Circulation - Ringer Lactate
2) ____________________________
3) Massive blood transfusion ( 6 dose)
4) Emergency Endoscopy

A

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
Q

Massive bleeding Varices management steps:

1) Airway, Breathing, Circulation - Ringer Lactate
2) Vasopressors - Somatostatins/Terlipressin
3) ____________________________
4) Emergency Endoscopy

A

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
Q

Massive bleeding Varices management steps:

1) Airway, Breathing, Circulation - Ringer Lactate
2) Vasopressors - Somatostatins/Terlipressin
3) Massive blood transfusion ( 6 dose)
4) ____________________________

A

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
Q

Emergency Endoscopy for Massive bleeding Varices management:

what is the most important treatment option here?

A

Single black mor tube - 250cc, inflated in gastric lumen to prevent esophageal bleeding

46
Q

What is TIPS ?

What is the side effect?

A

Transjugular Intrahepatic Portocaval shunt, Hepatic Encephalopathy is the s.e.

47
Q

For Procedural Prevention of Varices bleeding: What is the superior treatment Banding/Sclerotherapy?

A

Banding

48
Q

In Cirrhosis after Varices bleeding - Transfusion should have?

A

FFP + Prothrombin Complex Concentrate (PCC = all factors, except 8)

49
Q

Hepatorenal Syndrome - Laboratory Signs?

A

Creatinine > 3 mg/dL
Na Urine > 10 mEq
(Like prerenal azotemia)

50
Q

What is the Dietary treatment for Ascites in a state of Cirrhosis?

A

Sodium Restriction

51
Q

What is the Volume treatment for Ascites in a state of Cirrhosis?

A

Fusid & Spironolactone

Drainage/TIPS/Albumin Infusions

52
Q

What is the Vascular treatment for Ascites in a state of Cirrhosis?

A

Midodrine (Alpha-1 Antagonist)
Clonidine (Alpha-2 Agonist)
*Both cause Splanchnic Vasoconstriction

53
Q

What complication of Cirrhosis will cause LUQ pain, Thrombocytopenia and Leukopenia?

A

Hypersplenism and Splenomegaly

54
Q

What is the diagnosis for SBP?

A

Leukocytes in Ascites Fluid>250 units/microL

55
Q

What is the will indicate Peritoneal Dialysis causing for SBP?

A

Leukocytes in Ascites Fluid>100 units/microL

56
Q

Tx for SBP?

A

Cefotaxime (for E.coli most common bug)

57
Q

What are the possible treatment options for Hepatorenal Syndrome ?

A

Octreotide / Midodrine
Albumin IV
Liver Transplant

58
Q

Hepatic Encephalopathy - Pathognomonic Signs

A

Cirrhotic Patient with Asterixis

59
Q

What is the treatment for Hepatic Encephalopathy?

A

Hydration & Electrolytes

Lactulose & Rifaximin

60
Q

What are the factors in CHILD Score?

A 
Serum Bilirubin
Serum Albumin
PT
Ascites level
Hepatic Encephalopathy level
61
Q

What are the factors in MELD Score?

A

Serum Bilirubin
INR
Creatinine Level
(ALD + Cholestatic) / (Other Liver Diseases)

62
Q

Elevation in Blood pressure after standing up is called? Part of What syndrome?

A

Orthostatic Hypertension

Hepatopulmonary Syndrome in Cirrhosis

63
Q

alcoholic hepatitis or cirrhosis, hemolytic anemia, and hyperlipidemia =

A

Zieve’s Syndrome

64
Q

What are the types of Presinusoidal causes of Cirrhosis?

A

Congenital Hepatic Failure

Schistosomiasis

65
Q

What are the types of Postsinusoidal causes of Cirrhosis?

A

VOD

66
Q

HRS 1 Vs HRS 2

What is the main Difference?

A

HRS 1 - ACUTE

HRS 2 - CHRONIC

67
Q

What is the change in definition when 2 microbes are found in SBP?

A

(“Complete”) Peritonitis = 3 Types of Antibiotics

68
Q

Treatment of Osmotic High ICP in Cirrhosis?

A

Hypertonic Solution Carefully administered
Mannitol
45 Degrees Bed

69
Q

Changes in Hemochromatosis in

Ferritin & Transferrin Saturation

A

Changes in Hemochromatosis in

Ferritin↑ & Transferrin Saturation↑

70
Q

modified Maddrey’s discriminant function involves?

A

Bilirubin level, aPT & Control difference

71
Q

modified Maddrey’s discriminant function less than 32 indicates use of -

A

Glucocorticoids or Pentoxifylline in Cirrhosis

72
Q

Where does ALT is found in an hepatocyte? What does it tells us about pathogenesis of liver diseases?

A

Cytosolic Enzyme

Viral or Other Intracellular Infection is most probable

73
Q

Where does AST is found in an hepatocyte? What does it tells us about pathogenesis of liver diseases?

A

Mitochondrial Enzyme

Oxidative process is most probable

74
Q 
Sedatives/Narcotics
Hypovolemia
Hypokalemia
SBP
TIPS
Upper Esophageal Bleeding

Factors Predisposing to _____ __________ in Cirrhotic Patients

A 
Sedatives/Narcotics
Hypovolemia
Hypokalemia
SBP
TIPS
Upper Esophageal Bleeding

Factors Predisposing to Hepatic Encephalopathy in Cirrhotic Patients

75
Q

What is the cause of Osteopenia & Osteoporosis in Cirrhosis?

A

Interference of cholestasis with vitamin D metabolism.

76
Q

Gynecomastia
Testicular Atrophy
Spider Angiomas
Palmar Erythema

Cirrhosis Symptoms caused by Elevation in _______

A

Gynecomastia
Testicular Atrophy
Spider Angiomas
Palmar Erythema

Cirrhosis Symptoms caused by Elevation in Estrogen

77
Q

Why would there be overactivity of Plasmin in Cirrhosis?

A

Decreased alpha 2-Antiplasmin

GBA - Y4 (12 decks)

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