LIVER DISEASE AND CIRRHOSIS

Question 1

what is cirrhosis?

Answer 1

chronic and severe inflammation of the liver for an extended
period of time. The regenerative capacity of the liver is enormous; however, over a long time,
fibrosis will develop

Question 2

Causes of cirrhosis

Answer 2

1. alcohol.
2. primary biliary cirrhosis, 3.sclerosing cholangitis, 4.alpha-1 antitrypsin deficiency,
3. hemochromatosis, and 6.Wilson disease.

Question 3

complications of cirrhosis are due to

Answer 3

Portal hypertension develops

because of mechanical factors of fibrosis and regenerative liver nodules

Question 4

clinical presentatiom

Answer 4

• Low albumin
• Portal hypertension
• Esophageal varices
• Ascites
• Peripheral edema
• Elevated prothrombin time (prolonged due to loss of ability to synthesize clotting
factors)
• Splenomegaly
• Thrombocytopenia
• Spider angiomata
• Palmar erythema
• Asterixis
• Encephalopathy (possible)
• Jaundice (possible)

Question 5

Diagnosis of Ascites

Answer 5

paracentesis is a sample of the ascitic fluid

obtained by needle through the anterior abdominal wall to exclude infection (SBP)

Question 6

Spontaneous bacterial peritonitis is

Answer 6

idiopathic infection of ascites

Question 7

Diagnosis of SBP

Answer 7

culture of the fluid is

the most specific test

Question 8

TTT of SBP

Answer 8

Cefotaxime or ceftriaxone is the drug of choice for SBP
**the risk of recurrence is 70% per year. Therefore, treat the patient with
norfloxacin or ciprofloxacin daily
**Stop beta blocker
*albumin infusion
will decrease the risk of hepatorenal syndrome

Question 9

When SAAG ≥1.1, portal hypertension, the cause of ascites is increased hydrostatic pressure

Answer 9

When SAAG ≥1.1 and total protein <2.5 g/dL, the portal hypertension is due to
cirrhosis. (liver produces less protein due to decreased function).
• When SAAG ≥1.1 and total protein >2.5 g/dL, heart failure, Budd-Chiari (check JAK2
to work up P. vera)

Question 10

When SAAG <1.1, it means the ascitic fluid albumin level is high. Cancer and infections generally produce SAAG <1.1.

Answer 10

• When SAAG <1.1 and total protein <2.5 g/dL, there is nephrotic syndrome (protein is
lost in urine).
• When SAAG <1.1 and total protein >2.5 g/dL, there is carcinomatosis (think ovarian),
Tb (do peritoneum biopsy, which will have high lymphocytes in ascites, too)

Question 11

ascites, are managed with

Answer 11

1.diuretics
(spironolactone most useful in cirrhosis
2.Furosemide is
commonly added after spironolactone to increase volume removal

Question 12

furosemide without

spironolactone will lead to

Answer 12

hypokalemia, which can cause encephalopathy.

Question 13

Encephalopathy is managed with

Answer 13

lactulose
This converts the NH3 to NH4+, or ammonia to
ammonium
2. rifaximin

Question 14

HRS is diagnoised by

Answer 14

• Increased creatinine >1.5 mg/dL over days to weeks
• Lack of response to albumin infusion for 48 hours (stop diuretics, too)
• Exclusion of other causes of AKI (sepsis); must have normal urine (no blood or
protein)
• Type 1 is more severe with doubling of creatinine in 2 weeks.
• Type 2 is less severe with more gradual increase in creating.

Question 15

TTT of HRS

Answer 15

midodrine, octreotide and albumin

Question 16

Primary Biliary Cirrhosis is

Answer 16

an idiopathic autoimmune disorder (association with other autoimmune diseases, such as Sjögren syndrome, rheumatoid arthritis, and scleroderm)

Question 17

Clinical Presentation.

Answer 17

The most common 1.symptoms are fatigue and pruritus

2. elevated alkaline phosphatase
3. Osteoporosis and hypothyroidism

Question 18

Diagnosis

Answer 18

1. most common abnormality is elevated
   alkaline phosphatase and gamma glutamyl transpeptidase (GGTP)
   2.total IgM are elevated
   3.most specific blood test is the antimitochondrial antibody.
   4.Biopsy

Question 19

TTT

Answer 19

1. Ursodeoxycholic acid is primary treatment

2. Cholestyramine will help with the pruritus

Question 20

Primary Sclerosis Cholangitis

Answer 20

idiopathic disorder of the biliary system most commonly

associated with inflammatory bowel disease (IBD)

Question 21

Clinical Presentation and diagnosis

Answer 21

The most specific test for primary sclerosis cholangitis is ERCP or MRCP
2.the antimitochondrial antibody test will
be negativ
3.only liver disease without biopsy

Question 22

TTT

Answer 22

endoscopic therapy for strictures; cholestyramine for itching

Question 23

Hemochromatosis is

Answer 23

most common inherited genetic diseases. There is an overabsorption of iron in the duodenum

Question 24

clinical presentation

Answer 24

• Cirrhosis (most common finding)
• Hepatocellular cancer (15–20% of patients)
• Restrictive cardiomyopathy (15% of patients)
• Arthralgias,
*osteoarthritis
*skin hyperpigmentation, *diabetes, and
*secondary hypogonadism

Question 25

diagnosis

Answer 25

1.elevated transferrin saturation >55%
2.Ferritin is
also elevated
3.The most accurate test is a liver biopsy

Question 26

TTT

Answer 26

1. Phlebotomy

2. chelating agents deferoxamine and deferasirox

Question 27

Wilson Disease

Answer 27

autosomal recessive disorder leading to a diminished ability to excrete
copper from the body

Question 28

clinical presentation

Answer 28

• Copper builds up in the liver, brain, and cornea.
• Basal ganglia dysfunction contributes to the movement disorder which develops.
• Psychiatric disturbance is seen in 10% of patients.
• Kayser-Fleischer rings are found in the eye on slit-lamp examination.
• Tremor and Parkinson’s result in 35% of patients.
*Fanconi syndrome
* Hemolytic anemia

Question 29

Diagnosis

Answer 29

1. The most specific blood test for diagnosis is decreased ceruloplasmin
2. increased urinary copper.
3. single most specific test is liver biopsy

Question 30

TTT

Answer 30

1.Penicillamine and trientine are copper chelators
2.Oral zinc interferes with copper
absorption