OnlineMedEd: Intern Content - "Cirrhosis IV"

Question 1

True or false: HCC needs to be biopsied to be diagnosed.

Answer 1

False

An elevated AFP and a mass on RUQ US are diagnostic.

Question 2

What are the three phases of a triple phase CT?

Answer 2

• Early arterial
• Late arterial
• Venous

Question 3

Describe hepatopulmonary syndrome.

Answer 3

The liver induces vasodilation/edema in the lungs that leads to increased diffusion distance and thus hypoxemia.

This is worse with standing –called platypnea.

Question 4

How do you evaluate hepatopulmonary syndrome?

Answer 4

Echo with bubbles (just like an agitated saline study for PFO)

The dilated pulmonary vessels give a path for bubbles to sneak through.

Question 5

Why does hepatopulmonary syndrome preclude transplant?

Answer 5

Hepatopulmonary syndrome leads to pHTN with right heart failure. If you transplant a liver, the portal distention will dump into a failing right heart and lead to congestive hepatopathy in the new heart.

Question 6

What are the Milan criteria?

Answer 6

The Milan criteria determine which people with HCC can get transplants:
- If they have one lesion greater than 5 cm or 3 that are greater than 3 cms, then they cannot.