livers lol

Question 1

causes of liver cirrhosis

Answer 1

-alcoholic liver disease
-nonalcoholic liver disease
-hep b
-hep c

Question 2

monitoring of cirrhosis for HCC

Answer 2

6 monthly USS and AFP levels

Question 3

first line for assessing NAFLD

Answer 3

ELF –> enhanced liver fibrosis
measures 3 markers to grade severity of cirrhosis

Question 4

USS appearance in fibrosis

Answer 4

• Nodularity of the surface of the liver
• “corkscrew” appearance to the arteries with increased flow as they compensate for reduced portal flow
• Enlarged portal vein with reduced flow
• Ascites
• Splenomegaly

Question 5

Screening for high risk of fibrosis

Answer 5

Fibro scan = transient elastography
- measures elasticity using sound waves
- retesting every 2 yrs in those w high risk

Question 6

Those considered high risk for liver fibrosis

Answer 6

• Hepatitis C
• Heavy alcohol drinkers (men drinking > 50 units or women drinking > 35 units per week)
• Diagnosed alcoholic liver disease
• Non alcoholic fatty liver disease and evidence of fibrosis on the ELF blood test
• Chronic hepatitis B (although they suggest yearly for hep B)

Question 7

endoscopy use in liver cirrhosis

Answer 7

assess any varices w portal HTN
should be done every 3 yrs

Question 8

Whats in the child pugh score

Answer 8

Bilirubin
Albumin
INR
Ascites
encephalopathy

Question 9

WHat is the MELD score

Answer 9

to be done every 6 months in pts w compensated cirrhosis
to assess requirement for dialysis
uses bilirubin, creatinine, INR and sodium
Gives a 3 mnth mortality –> guides transplant refferal

Question 9

WHat is the MELD score

Answer 9

to be done every 6 months in pts w compensated cirrhosis
to assess requirement for dialysis
uses bilirubin, creatinine, INR and sodium
Gives a 3 mnth mortality –> guides transplant refferal

Question 10

Mx of ascites

Answer 10

Low sodium diet
spirinolactone
Paracentesis (ascitic tap or ascitic drain)
Prophylactic antibiotics against SBP (ciprofloxacin or norfloxacin) in patients with less than 15g/litre of protein in the ascitic fluid
Consider TIPS procedure in refractory ascites
Consider transplantation in refractory ascites

Question 11

Mx of hepatic encephalopathy

Answer 11

• Laxatives (i.e. lactulose) promote the excretion of ammonia, aim is 2-3 soft motions daily, may require enemas initially
• Abx reduce number of intestinal bacteria producing ammonia, Rifaximin is useful as it is poorly absorbed so stays in the GI tract
  Nutritional support –>may need nasogastric feeding