Liver Disease

Question 1

chronic liver disease can produce, 4 high yield sindromes

Answer 1

Thrombocytopenia from splenic sequestration
Renal insufficiency (hepatorenal syndrome)
Hepatopulmonary syndrome

Coagulopathy (all clotting factors except VIII are made in liver)

Question 2

liver cancer screening, who should get it, what test and how frequently?

Answer 2

Everyone with cirrhosis should get an ultrasound (US) every 6 months

Question 3

Ascites - Paracentesis should be performed if there is:

Answer 3

New-onset ascites
Abdominal pain and tenderness
Fever

Question 4

serum ascites albumin gradient SAAG: Correlating Level with Specific Diseases IF >1.1 g/dL

Answer 4

Portal hypertension
CHF
Hepatic vein thrombosis
Constrictive pericarditis

Question 5

serum ascites albumin gradient SAAG: What diseases are present when if SAAG <1.1?

Answer 5

Infections (except SBP)
Cancer
Nephrotic syndrome

Question 6

Spontaneous Bacterial Peritonitis etiologic agent

Answer 6

E coli most common

Question 7

when to do Spontaneous Bacterial Peritonitis prophylaxis.

Answer 7

All variceal bleeding with ascites

Anyone with SBP needs lifelong prophylaxis against recurrence.

When the
ascites fluid albumin level is quite low

Question 8

Spontaneous Bacterial Peritonitis Best initial test:

Answer 8

Cell count with more than 250 neutrophils is the basis upon

which we start therapy.

Question 9

Spontaneous Bacterial Peritonitis other useless tests

Answer 9

Gram stain is almost always negative

LDH level is too nonspecific.

Question 10

Spontaneous Bacterial Peritonitis most accurate test,

Answer 10

Fluid culture

Question 11

Spontaneous Bacterial Peritonitis Treatment

Answer 11

cefotaxime or ceftriaxone

Question 12

Spontaneous Bacterial Peritonitis profilaxis

Answer 12

norfloxacin or trimethoprim/sulfamethoxazole

Question 13

Cirrhosis: Ascites and edema. Tx

Answer 13

Spironolactone and other diuretics.

Serial paracenteses for large-volume ascites.

Question 14

Cirrhosis: Coagulopathy and

thrombocytopenia Tx

Answer 14

FFP and/platelets only if bleeding occurs

Question 15

Cirrhosis: Encephalopathy Tx

Answer 15

Lactulose and rifaximin

Question 16

Cirrhosis: Hypoalbuminemia Tx

Answer 16

No specific therapy

Question 17

Cirrhosis: Spider angiomata and

palmar erythema Tx

Answer 17

No specific therapy

Question 18

Cirrhosis: Varices Tx

Answer 18

Propranolol and banding via endoscopy

Question 19

Cirrhosis: Hepatorenal syndrome Tx

Answer 19

Somatostatin (octreotide), midodrine

Question 20

Cirrhosis: Hepatopulmonary

syndrome Tx

Answer 20

No specific therapy

Question 21

Acute Alcoholic Hepatitis Cx Fx

Answer 21

jaundice, anorexia, and weight loss over a few months with right upper
quadrant pain.

ascites, liver
tenderness, and fever.

Question 22

Acute Alcoholic Hepatitis labs show
AST
ALT
 GGTP
bilirubin
 INR
prothrombin time (PT)

Answer 22

AST > ALT
Elevated GGTP and bilirubin
Elevated INR and prothrombin time (PT)

Question 23

Discriminant factor=?

Answer 23

4.6 × (Patient’s PT – Control PT) + Bilirubin.

Question 24

If the discriminant factor is

>32, treat with

Answer 24

steroids.

Question 25

Hepatopulmonary Syndrome CxFx

Answer 25

orthodeoxia, which is hypoxia upon sitting upright

Question 26

Hepatopulmonary Syndrome tx

Answer 26

There is no specific therapy.

If the liver’s condition is this bad, the patient needs a transplant.

Question 27

SAAG = (albumin levels in ___) - (albumin levels in ___)

Answer 27

serum

ascitic fluid