liver cirrhosis

Question 1

what causes cirrhosis

Answer 1

necrosis of liver cells followed by fibrosis and nodule formation, bands of fibrosis separate hypatocytes

Question 2

is cirrhosis reversible

Answer 2

no

Question 3

what initiates fibrosis

Answer 3

activation of the stellate cells

Question 4

what is activation of stellate cells followed by

Answer 4

proliferation of fibrolasts and the deposition of collagen

Question 5

Macronodular

Answer 5

nodules of variable size and normal acini seen within larger nodules

Question 6

what is Macronodular seen following

Answer 6

chronic viral hep

Question 7

Micronodular following

Answer 7

alcohol damage or biliary tract disease

Question 8

what are compensated patients clinically

Answer 8

normal

Question 9

CF compensated patients

Answer 9

spider naevi, clubbing, palmar erythema, gynaecomastia, splenomegaly or NONE.

Question 10

decompensated patients

Answer 10

develop liver failure

Question 11

what is decompensated cirrhosis usually precipitated by

Answer 11

infection or insult

Question 12

decompensated CF

Answer 12

jaundice, ascites, bruising encephalopathy.

Question 13

what is bruising a result of

Answer 13

the liver not making enough clotting factors

Question 14

what are the true liver function tests

Answer 14

albumin and PT time

Question 15

what does low Na indicate

Answer 15

severe liver disease due to a defect in free water clearance or excess diuretic therapy

Question 16

complications

Answer 16

portal hypertension, ascites , liver failure and encephalopathy and variceal bleeding

Question 17

what is encephalopathy

Answer 17

as liver fails, nitrogenous waste builds up as ammonia, ass passes to brain where it is cleared by astrocytes, excess glutamine causes cerebral oedema

Question 18

encephalopathy diagnosis

Answer 18

confusion, neck pain or stiffness

Question 19

encephalopathy treatment

Answer 19

lactulose to clear gut, maintain nutrition, transplant

Question 20

what antibiotic would you use in encephalopathy

Answer 20

rifaxamin

Question 21

what classification do we use to predict liver dysfunction

Answer 21

child pugh

Question 22

which grade of child pugh is most severe

Answer 22

c

Question 23

what are some prehpatic causes of portal hypertension

Answer 23

portal vein thrombosis or occlusion

Question 24

what are some intrahepatic causes of portal hypertension

Answer 24

Presinusoidal -Schistosomiasis, non-cirrhotic portal hypertension
Postsinusoidal - Cirrhosis, alcoholic hepatitis, congenital fibrosis

Question 25

management of ascites

Answer 25

spironolactone
paracentesis
TIPSS
transplant

Question 26

what is SBP

Answer 26

infection of the ascitic fluid without an apparent cause

Question 27

what patients would you suspect SBP in

Answer 27

deteriorate suddenly

Question 28

what must you do in all patients with ascites to check for SBP

Answer 28

tap in all ascite and cell count

- neutrohphils > 250 cells/mm^3

Question 29

management of SBP

Answer 29

antibiotics and alba

terlipressin