OnlineMedEd: Gastroenterology - "Cirrhosis"

Question 1

Go through the advanced organizer for cirrhosis.

Answer 1

VW HAPPENS
•Viral hepatitis
• Wilson's disease
•Hemochromatosis
• Alpha-1 antitrypsin deficiency 
•Primary sclerosing cholangitis
• Primary biliary cirrhosis 
•ETOH
•Non-alcoholic steatohepatitis 
•Something else

Question 2

Hepatitis C is more commonly from ___________, while hepatitis B is more commonly from ___________.

Answer 2

IV drug abuse; sex

Question 3

How can you diagnose cirrhosis from hepatitis?

Answer 3

Antibody screen

Question 4

True or false: test serum copper levels to diagnose Wilson’s disease.

Answer 4

False

Serum ceruloplasmin is the more sensitive test. Urinary copper excretion can be done.

Question 5

True or false: transplant should not be offered to those with hepatitis cirrhosis.

Answer 5

False-ish

It’s true you should not do a liver transplant in someone with active infection, but once the infection is cured then a transplant can be curative. For example, if someone has cirrhosis from chronic HCV, then you could cure it with sofosbuvir and then do a transplant to fix the complications of cirrhosis.

Question 6

Why can’t you do a transplant to cure hemochromatosis?

Answer 6

The defective enzyme is in the gut –remember that it’s caused by the inability to sense iron levels leading to excess absorption –so the iron deposition will repeat.

(Technically, though, if you transplanted someone and then controlled their iron through therapeutic phlebotomy they should be ok?)

Question 7

Differentiate PSC/PBC.

Answer 7

• PSC:

• male predominance
• extrahepatic (obvious, non-subtle), onion-skin fibrosis (think of guys smelling like onions)
• associated with ulcerative colitis

•PBC:

• female predominance (B stands for Bitch)
• intrahepatic fibrosis
• associated with anti-mitochondrial antibodies
• granulomas

Question 8

How do you diagnose PSC?

Answer 8

MRCP (MRI of the gallbladder and pancreas) looking for the “beads on a string” sign

Question 9

The only treatment for PBC and PSC is ______________.

Answer 9

transplant

Question 10

How do you diagnose alcoholic cirrhosis and NASH?

Answer 10

Both are diagnoses of exclusion from the history –just make sure they have no hepatitis (serology), Wilson’s disease symptoms (history), hemochromatosis symptoms (history again), A1ATD (no COPD). PSC and PBC is hard to rule out by history.