OnlineMedEd: Gastroenterology - "Cirrhosis Complications"

Question 1

The two main components of bile are _________________.

Answer 1

bilirubin and bile salts

Question 2

List the two main symptoms of hepatic encephalopathy.

Answer 2

• AMS

* Asterixis

Question 3

Hepatic encephalopathy can be treated with what three things?

Answer 3

• Lactulose
• Rifaximin
• Zinc

Question 4

Review the labs that will be abnormal in someone with cirrhosis and the complications from each.

Answer 4

• NH3 elevated: hepatic encephalopathy
• Estrogen elevated: gynecomastia, palmar erythema, and spider angiomata
• Albumin decreased: peripheral edema
• Bile salts increased: pruritus
• Bilirubin increased: jaundice
• Coagulation proteins decreased: increased INR

Question 5

Long-term, esophageal varices can be treated by __________________.

Answer 5

use of non-selective beta-blockers (nadolol, propranolol) to decrease portal HTN

Question 6

The major complication of TIPS is ________________.

Answer 6

hepatic encephalopathy (you bypass the liver so all the NH3 goes to the brain)

Question 7

How can you determine the type of ascites?

Answer 7

Recall that ascites can be related to portal HTN or not.

To determine if it is portal HTN, do a serum-ascites albumin gradient (SAAG). If it’s greater than 1.1, then it is portal HTN –could be cirrhosis or right-heart failure.

Question 8

In terms of physical exam maneuvers, ______________ can be helpful in diagnosing ascites.

Answer 8

testing for tympany on percussion while the patient lies flat and then on his/her sides

Gravity will pull the fluid down and tympany will not occur where the fluid has accumulated.

Question 9

How should you manage ascites?

Answer 9

• Fluid restriction
• Salt restriction
• Furosemide
• Spironolactone
• Paracentesis

Question 10

A person with cirrhosis has any kind of change from baseline. You should immediately think ___________.

Answer 10

spontaneous bacterial peritonitis

Look for abdominal pain, fever, AMS.

Diagnosis is made with a paracentesis showing PMNs greater than 250.

Question 11

Describe prophylactic treatment of SBP.

Answer 11

Any patient with cirrhosis and a total protein less than 1.0 should be given a fluoroquinolone to prevent SBP.

Question 12

Symptomatic SBP should be treated with _______________.

Answer 12

IV ceftriaxone

Question 13

A paracentesis comes back culture negative but PMNs greater than 250. What should you do?

Answer 13

Still treat with IV ceftriaxone.

Question 14

All patients with HCC have had _____________.

Answer 14

cirrhosis or HBV

Question 15

How do you diagnose HCC?

Answer 15

• RUQ US
• Alpha-feto protein
• Triple-phase CT