Hepatic Cirrhosis Lecture Powerpoint

Question 1

Cirrhosis definition

Answer 1

Chronic IRREVERSIBLE disease of the liver marked by degeneration of the cells, inflammation, and fibrous thickening of the tissue

Question 2

Histology of liver cirrhosis grading

Answer 2

Grade 0-3 inflammation

Grade 0-3 level of fibrosis

Question 3

Leading cause of chronic hepatitis and cirrhosis

Answer 3

Hepatitis C

Question 4

Common causes of cirrhosis (5)

Answer 4

• hep C
• alcoholic liver disease
• nonalcoholic fatty liver disease
• amiodarone and methotrexate
• hemochromatosis

Question 5

Cirrhosis presentation (6)

Answer 5

• may be asymptomatic other than fatigue
• may be severe symptoms related to functions affected
• weight loss or weight gain
• jaundice
• asterixis
• caput medusa and hepatomegaly

Question 6

Muehrke’s lines

Answer 6

PE finding sometimes related to cirrhosis or nephrotic syndrome or albumin deficiency involving double white lines that run across the fingernails horizontally

Question 7

Terry’s nails

Answer 7

PE finding where nails are entirely white except for the tips which remain pink, often indicative of cirrhosis

Question 8

Spider angioma

Answer 8

A physical exam finding on the skin of an erythemous spider web shaped lesion indicative of cirrhosis in a patient

Question 9

Pre vs intra vs post hepatic causes of portal hypertension

Answer 9

• splenic vein thrombosis
• cirrhosis
• chronic right heart failure

Question 10

Gastroesophageal varicies on EGD are diagnostic for clinically signficant…

Answer 10

….portal hypertension

Question 11

Esophageal varicies grading

Answer 11

1-3, presence of wheel indicates recent or impending bleed

Question 12

2 prophylactic treatments against esophageal varices

Answer 12

• nonselective B blocker

- banding

Question 13

Gastric varices are ___ likely to bleed but have a ___ mortality rate

Answer 13

less, higher

Question 14

Top 4 causes of ascites

Answer 14

• Cirrhosis
• neoplasm
• CHF
• TB peritonitis

Question 15

Serum ascites albumin gradient (SAAG)***

Answer 15

(Albumin conc. of serum) - (albumin conc. of ascitic fluid)

If greater than 1.1 then indicates a nonperitoneal cause of ascites, if less than 1.1 indicates a peritoneal cause of ascites

Question 16

Ascites diagnostic studies (3)

Answer 16

• a good PE
• doppler ultrasound
• diagnostic paracentesis

Question 17

Mild ascites treatment options (2)

Answer 17

• sodium restriction

- diuretics 1-2x a week

Question 18

Moderate to severe ascites treatment options (2)

Answer 18

• spironolactone

- furosemide

Question 19

Goal value for moderate to severe ascites treatment per day

Answer 19

.5-1kg per day

Question 20

Spontaneous bacterial peritonitis

Answer 20

Very highly recurring common reason for patients with previously managed ascites to tip caused by translocations of GI tract bacteria across gut wall

Question 21

Spontaneous bacterial peritonitis diagnostic study (1)

Answer 21

-Diagnostic paracentesis with eval of ascitic fluid >250 PMN’s/mm with pos culture**

Question 22

Spontaneous bacterial peritonitis treatment options (1)

Answer 22

ceftraxime

Question 23

Hepatic encephalopathy

Answer 23

Range of symptoms from mild to severe involving personality change, depressed consciousness, or intelectula impairment occurring in majority of patients with cirrhosis often associated with asterexis and associated with an elevated ammonia level (sometimes, NOT diagnostic)***

Question 24

Hepatic encephalopathy treatment (2)

Answer 24

• lactulose (stimulates passage of ammonia but causes loose stool)
• rifaximin

Question 25

TIPS procedure

Answer 25

Transjugular intrahepatic portosystemic shunt that connects portal vein to hepatic vein bypassing liver circulation indicated for management of variceal bleeding or of refractory ascites, but can induce or worsen underlying hepatic encephalopathy due to lack of blood filtering

Question 26

Hepatorenal syndrome

Answer 26

Caused by vasoconstriciton of large and small renal arteries resulting in impaired renal perfusion and continuum of renal dysfunction, seen in patients with combo of cirrhosis and ascites, either type I (rapid progressive liver failure) or type II (slow and better prognosis)

Question 27

Hepatorenal syndrome diagnosis (1)

Answer 27

Creatinine clearence <40ml/min not explained by pre-existing renal disease, nephrotoxins or diuretic use

Question 28

Hepatorenal syndrome treatment (3)

Answer 28

- albumin - octreotide - transplant

Question 29

Hep B, C, or D patients with cirrhosis are at high risk of what type of cancer?

Answer 29

Hepatocellular carcinoma (HCC)

Question 30

Child turcotte pugh (CTP) system

Answer 30

Scoring system for cirrhosis where greater than 10 indicates a 50% chance of death within one year

Question 31

Model for end stage liver disease (MELD) score

Answer 31

Liver transplant program scoring system for cirrhosis to assess severity of condition, recipient >25 may not be candidate

Question 32

Liver transplant info

Answer 32

Despite up to 7000 transplants every year 12-15% are still dying yearly, should be referred at first evidence of decompensated cirrhosis, contraindicated in those with cardiovasculr or pulmonary disease or alcohol and drug abuse, viral load detectable HIV in bloodstream

Question 33

Liver cirrhosis preventative strategies (4)

Answer 33

- immunization - avoid hepatotoxic meds such as NSAIDs, erythromycin, statins, etc - avoid anesthesia (reduces hepatic blood flow) - diet