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Hepatology > Pthn2 Last 50 > Flashcards

Pthn2 Last 50 Flashcards

1
Q

What is the clinical presentation of portal hypertension as described in IMG_1962.jpeg?

A

Clinical presentation includes dilated anterior abdominal wall veins (caput medusae), ascites, and esophageal varices which may lead to hematemesis.

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2
Q

What are the causes of splenomegaly mentioned in IMG_1962.jpeg?

A

Causes include prehepatic causes (e.g., portal vein obstruction), hepatic causes (e.g., liver disease), and posthepatic causes (e.g., congestive liver).

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3
Q

What investigations are recommended for diagnosing portal hypertension in IMG_1962.jpeg?

A

Investigations include abdominal examination for dilated veins, ultrasound for liver and spleen size, and endoscopy for esophageal varices.

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4
Q

What is the treatment for esophageal varices as mentioned in IMG_1962.jpeg?

A

Treatment includes endoscopic band ligation, beta-blockers to reduce portal pressure, and in severe cases, transjugular intrahepatic portosystemic shunt (TIPS).

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5
Q

What are the causes of ascites in liver disease, as mentioned in IMG_1962.jpeg?

A

Causes include portal hypertension, hypoalbuminemia, and sodium retention due to liver dysfunction.

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6
Q

What is the clinical presentation of hematomas in prolonged cases of portal hypertension, as mentioned in IMG_1962.jpeg?

A

In prolonged cases, hematomas from esophageal varices may occur, which can be mild or life-threatening.

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7
Q

What are the causes of prehepatic splenomegaly mentioned in IMG_1962.jpeg?

A

Prehepatic causes include portal vein obstruction and splenic vein thrombosis.

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8
Q

What is the treatment for ascites in liver disease, as mentioned in IMG_1962.jpeg?

A

Treatment includes sodium restriction, diuretics (e.g., spironolactone), and paracentesis for symptomatic relief.

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9
Q

What are the investigations for splenomegaly mentioned in IMG_1962.jpeg?

A

Investigations include ultrasound to assess spleen size and blood tests to evaluate for underlying causes like liver disease or infections.

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10
Q

What is the clinical presentation of caput medusae in portal hypertension, as mentioned in IMG_1962.jpeg?

A

Caput medusae refers to dilated veins around the umbilical region and is a sign of severe portal hypertension.

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11
Q

What are the causes of hepatic splenomegaly mentioned in IMG_1962.jpeg?

A

Hepatic causes include hepatomegaly, mild to moderate splenomegaly, and shrunken liver in advanced hepatic diseases.

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12
Q

What is the treatment for hematemesis due to esophageal varices, as mentioned in IMG_1962.jpeg?

A

Treatment includes resuscitation, vasoactive drugs (e.g., octreotide), endoscopic therapy, and antibiotics to prevent infection.

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13
Q

What are the investigations for esophageal varices mentioned in IMG_1962.jpeg?

A

Investigations include endoscopy to visualize varices and imaging studies like ultrasound to assess portal hypertension.

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14
Q

What is the clinical presentation of ascites in advanced liver disease, as mentioned in IMG_1962.jpeg?

A

Clinical presentation includes abdominal distension, fluid wave on examination, and hypoalbuminemia.

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15
Q

What are the causes of posthepatic splenomegaly mentioned in IMG_1962.jpeg?

A

Posthepatic causes include congested liver and mild splenomegaly due to obstruction.

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16
Q

What is the treatment for portal hypertension, as mentioned in IMG_1962.jpeg?

A

Treatment includes beta-blockers to reduce portal pressure, endoscopic therapy for varices, and TIPS in severe cases.

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17
Q

What are the investigations for caput medusae mentioned in IMG_1962.jpeg?

A

Investigations include abdominal ultrasound to assess portal vein flow and CT/MRI to evaluate liver and spleen.

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18
Q

What is the clinical presentation of hematemesis in portal hypertension, as mentioned in IMG_1962.jpeg?

A

Hematemesis presents as vomiting of blood and is a life-threatening complication of esophageal varices.

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19
Q

What are the causes of congestive gastropathy mentioned in IMG_1962.jpeg?

A

Causes include portal hypertension leading to gastric mucosal changes and gastric bleeding.

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20
Q

What is the treatment for congestive gastropathy, as mentioned in IMG_1962.jpeg?

A

Treatment includes proton pump inhibitors (PPIs) and management of portal hypertension.

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21
Q

What are the investigations for hematomas in portal hypertension, as mentioned in IMG_1962.jpeg?

A

Investigations include endoscopy to identify the source of bleeding and imaging studies to assess liver and spleen.

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22
Q

What is the clinical presentation of shrunken liver in advanced hepatic diseases, as mentioned in IMG_1962.jpeg?

A

A shrunken liver is a sign of advanced hepatic disease and is often associated with cirrhosis.

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23
Q

What are the causes of rectal hemorrhoids in portal hypertension, as mentioned in IMG_1962.jpeg?

A

Causes include increased portal pressure leading to venous dilation in the rectal area.

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24
Q

What is the treatment for rectal hemorrhoids, as mentioned in IMG_1962.jpeg?

A

Treatment includes sclerotherapy, banding, and management of portal hypertension.

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25
Q

What are the investigations for hypoalbuminemia mentioned in IMG_1962.jpeg?

A

Investigations include serum albumin levels and liver function tests to assess liver synthetic function.

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26
Q

What is the main topic discussed in IMG_1962.jpeg?

A

The main topic is Hematology, focusing on splenomegaly, portal hypertension, and related clinical features.

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27
Q

What is splenomegaly, and what are its causes as mentioned in IMG_1962.jpeg?

A

Splenomegaly is the enlargement of the spleen. Causes mentioned include prehepatic causes (e.g., portal vein obstruction), hepatic causes (e.g., liver disease), and posthepatic causes (e.g., congestive liver).

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28
Q

What are the clinical features of portal hypertension as described in IMG_1962.jpeg?

A

Clinical features include dilated anterior abdominal wall veins (caput medusae), ascites, and esophageal varices which may lead to hematemesis.

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29
Q

What are the prehepatic causes of splenomegaly mentioned in IMG_1962.jpeg?

A

Prehepatic causes include portal vein obstruction and splenic vein thrombosis.

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30
Q

What are the hepatic causes of splenomegaly mentioned in IMG_1962.jpeg?

A

Hepatic causes include hepatomegaly, mild to moderate splenomegaly, and shrunken liver in advanced hepatic diseases.

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31
Q

What are the posthepatic causes of splenomegaly mentioned in IMG_1962.jpeg?

A

Posthepatic causes include congested liver and mild splenomegaly due to obstruction.

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32
Q

What is the significance of caput medusae in portal hypertension, as mentioned in IMG_1962.jpeg?

A

Caput medusae refers to dilated veins around the umbilical region and is a sign of severe portal hypertension.

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33
Q

What are the complications of esophageal varices mentioned in IMG_1962.jpeg?

A

Complications include hematemesis (vomiting of blood), which can be mild or life-threatening.

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34
Q

What is the clinical significance of ascites in advanced liver disease, as mentioned in IMG_1962.jpeg?

A

Ascites is a sign of advanced liver disease and is associated with hypoalbuminemia and sodium retention.

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35
Q

What are the investigations mentioned for diagnosing portal hypertension in IMG_1962.jpeg?

A

Investigations include abdominal examination for dilated veins, ultrasound for liver and spleen size, and endoscopy for esophageal varices.

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36
Q

What is the significance of hematemesis in portal hypertension, as mentioned in IMG_1962.jpeg?

A

Hematemesis is a life-threatening complication of esophageal varices and indicates severe portal hypertension.

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37
Q

What is the role of hypoalbuminemia in the development of ascites, as mentioned in IMG_1962.jpeg?

A

Hypoalbuminemia reduces oncotic pressure, leading to fluid accumulation in the abdominal cavity (ascites).

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38
Q

What are the early signs of portal hypertension mentioned in IMG_1962.jpeg?

A

Early signs include splenomegaly and dilated abdominal wall veins.

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39
Q

What is the significance of organomegaly in portal hypertension, as mentioned in IMG_1962.jpeg?

A

Organomegaly, particularly splenomegaly, is a key feature of portal hypertension and can indicate the underlying cause (prehepatic, hepatic, or posthepatic).

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40
Q

What is the clinical picture of hematomas in prolonged cases of portal hypertension, as mentioned in IMG_1962.jpeg?

A

In prolonged cases, hematomas from esophageal varices may occur, which can be mild or life-threatening.

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41
Q

What is the significance of dilated veins around the umbilical region in portal hypertension, as mentioned in IMG_1962.jpeg?

A

Dilated veins around the umbilical region, known as caput medusae, are a sign of severe portal hypertension.

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42
Q

What is the role of sodium retention in the development of ascites, as mentioned in IMG_1962.jpeg?

A

Sodium retention contributes to fluid accumulation in the abdominal cavity, leading to ascites.

43
Q

What are the advanced signs of portal hypertension mentioned in IMG_1962.jpeg?

A

Advanced signs include ascites, hematemesis, and hepatic encephalopathy.

44
Q

What is the significance of shrunken liver in advanced hepatic diseases, as mentioned in IMG_1962.jpeg?

A

A shrunken liver is a sign of advanced hepatic disease and is often associated with cirrhosis.

45
Q

What is the clinical significance of hyperglycemia in prehepatic causes of splenomegaly, as mentioned in IMG_1962.jpeg?

A

Hyperglycemia may occur in prehepatic causes of splenomegaly and can lead to pancytopenia.

46
Q

What is the significance of congestive gastropathy in portal hypertension, as mentioned in IMG_1962.jpeg?

A

Congestive gastropathy refers to gastric mucosal changes due to portal hypertension and can lead to gastric bleeding.

47
Q

What is the role of rectal hemorrhoids in portal hypertension, as mentioned in IMG_1962.jpeg?

A

Rectal hemorrhoids are a complication of portal hypertension and can cause bleeding.

48
Q

What is the procedure for inflating balloons in the treatment of internal hemorrhoids?

A

Balloons inflated through catheter in the nose

49
Q

What is the primary function of sclerotherapy in the context of esophageal varices?

A

Sclerotherapy (ethanolamine oleate) or Ligation for esophageal varices

50
Q

What is the significance of endoscopy in the treatment of esophageal varices?

A

Diagnostic & Therapeutic

51
Q

Name one emergency surgical measure for treating pre hepatic thrombosis.

A

Surgical Porto-systemic shunt

52
Q

What does TIPSS stand for?

A

Trans-jugular Intrahepatic Porto-systemic Shunt

53
Q

What is a potential treatment option for end-stage liver disease?

A

Liver transplantation

54
Q

What is a recommended strategy to prevent re-bleeding after the first attack?

A

Prophylactic Band ligation or sclerotherapy

55
Q

Which medications are suggested for the prevention of re-bleeding after the first attack?

A

Propranolol (Beta blocker)

56
Q

What are the treatment options after a second attack of esophageal varices?

A
  • Beta adrenergic blockers (propranolol)
  • Endoscopic sclerotherapy or band ligation
  • Surgical porto-systemic shunt
  • Liver transplantation
57
Q

Fill in the blank: The balloon catheter is used to _______ the tract.

A

dilate

58
Q

True or False: Avoiding aspirin and NSAIDs is recommended after the first attack of varices.

A

True

59
Q

What is the role of the inferior vena cava in the context of balloon catheter procedures?

A

Shunts blood from varices

60
Q

What should be avoided during the treatment of varices to prevent complications?

A

Aspirin and NSAID

61
Q

What is the purpose of using a guidewire during the procedure?

A

To assist in catheter placement

62
Q

Fill in the blank: The portal vein is associated with _______ and varices.

A

decompressed

63
Q

What are the laboratory findings for liver function tests in pre-hepatic causes?

A

Normal functions

Pre-hepatic causes typically do not impair liver function tests.

64
Q

What are the laboratory findings for liver function tests in hepatic causes?

A

Impaired functions

Hepatic causes indicate a dysfunction of the liver.

65
Q

What hematological findings might indicate bleeding or hypersplenism?

A

Anemia or pancytopenia

Anemia suggests bleeding, while pancytopenia indicates hypersplenism.

66
Q

What imaging technique assesses the patency and direction of flow in the portal vein?

A

Doppler flow

Doppler flow studies are crucial for evaluating portal vein status.

67
Q

What does ultrasonography evaluate in liver pathology?

A

Liver size, spleen, ascites

Ultrasonography provides a non-invasive assessment of liver and spleen morphology.

68
Q

What imaging methods are used to assess vessel patency?

A

CT angiography and MR Venography

Both CT angiography and MR venography are advanced imaging techniques for vascular evaluation.

69
Q

What is the role of a liver biopsy in the context of hepatic fibrosis?

A

Should be done after correction of coagulopathy

Liver biopsy is invasive and requires careful management of coagulopathy.

70
Q

What is the purpose of upper GIT endoscopy in liver disease?

A

Detection of esophageal varices or ulcers

Endoscopy allows direct visualization and assessment of esophageal conditions.

71
Q

What is the first step in the emergency treatment of bleeding varices?

A

ICU Hospitalization and first aid measures (ABC)

Initial management focuses on stabilizing the patient.

72
Q

What IV fluid is recommended for a shocked patient?

A

Saline 20 ml/kg

IV fluids are critical for volume resuscitation in shock.

73
Q

What is the recommended blood transfusion volume for managing bleeding?

A

10 - 20 ml/kg

Blood transfusions help restore blood volume and improve oxygen carrying capacity.

74
Q

What treatments are used to correct coagulopathy in bleeding varices?

A

Fresh frozen plasma, IV Vitamin K, and platelets

These treatments are essential for managing coagulopathy during bleeding episodes.

75
Q

What types of drugs are used to manage bleeding varices?

A

H2 receptor blockers or Proton Pump Inhibitors (PPI)

These medications reduce gastric acid secretion, helping to prevent further erosion.

76
Q

What is the function of vasopressin infusion in bleeding varices?

A

Decreases portal flow

Vasopressin helps control bleeding by constricting splanchnic vessels.

77
Q

What is the purpose of a naso-gastric tube in the context of bleeding varices?

A

For gastric wash and to monitor ongoing losses

Naso-gastric tubes are crucial for managing gastrointestinal bleeding.

78
Q

What is a compression tube used for in treating bleeding varices?

A

Mechanical compression for bleeding varices (not more than 48H)

Compression tubes can help control bleeding but should be used with caution.

79
Q

True or False: Compression tubes can be used indefinitely for bleeding varices.

A

False

Compression tubes should not be used for more than 48 hours to avoid complications.

80
Q

What is the primary cause of splenomegaly in hepatology?

A

Congestion of abdominal viscera drained by portal vein

This occurs due to increased pressure in the portal venous system.

81
Q

What are the consequences of portal hypertension related to blood flow?

A

Development of collaterals carrying blood from portal venous system to systemic circulation

This can lead to various complications, including varices.

82
Q

List three high-risk conditions associated with gastrointestinal bleeding due to portal hypertension.

A
  • Esophageal varices
  • Gastric varices
  • Rectal hemorrhoids (Piles)

These conditions arise from increased pressure in the portal system.

83
Q

What is Caput Medusae?

A

Dilated veins around the umbilicus

This is a visible sign of portal hypertension.

84
Q

Which vein is associated with the development of collateral circulation in portal hypertension?

A

Azygos vein

This vein can provide alternative pathways for blood flow.

85
Q

What is hematemesis?

A

Vomiting blood

This can occur as a result of bleeding from esophageal varices.

86
Q

What does ascites indicate in advanced liver disease?

A

Hypoalbuminemia & sodium retention

It is a common manifestation in patients with liver dysfunction.

87
Q

What is a key prehepatic cause of splenomegaly?

A

Significant & early splenomegaly with normal liver function

This can occur due to portal vein obstruction.

88
Q

What condition may lead to pancytopenia in the context of splenomegaly?

A

Hypersplenism

This condition results from an enlarged spleen sequestering blood cells.

89
Q

What are the hepatic causes of splenomegaly?

A
  • Hepatomegaly
  • Mild to Moderate Splenomegaly
  • Shrunken liver in advanced hepatic diseases

These conditions reflect liver dysfunction and its effects on the spleen.

90
Q

What is the clinical picture of hematemesis from esophageal varices?

A

May be the first manifestation; may be mild or massive life-threatening

This can indicate severe portal hypertension and warrants immediate medical attention.

91
Q

What examination findings are associated with advanced liver disease?

A
  • Ascites
  • Organomegaly

These findings are common in patients with significant liver dysfunction.

92
Q

True or False: Markedly congested liver with no splenomegaly indicates supra-hepatic obstruction.

A

True

This condition can occur early in the obstruction process.

93
Q

What is the definition of portal hypertension?

A

Portal venous pressure more than 10-12 mm Hg (Normal: 5-10 mm Hg)

Portal hypertension can lead to various complications and is often associated with liver disease.

94
Q

What are pre-hepatic causes of portal hypertension?

A

• Portal vein thrombosis
• Splenic vein thrombosis
• Mesenteric vein thrombosis

Pre-hepatic causes often involve blockages before blood reaches the liver.

95
Q

What is the commonest cause of umbilical vein thrombosis?

A

Umbilical thrombophlebitis

This condition can occur due to umbilical catheterization or infections such as omphalitis.

96
Q

List some intra-hepatic causes of portal hypertension.

A

• Fibrosis
• Hepatocellular disease
• Congenital hepatic fibrosis
• Chronic hepatitis
• Cirrhosis
• Veno-occlusive disease

Intra-hepatic causes are related to conditions affecting the liver tissues directly.

97
Q

What are examples of biliary tract diseases associated with portal hypertension?

A

• Biliary atresia (EHBA)
• Cystic fibrosis
• Sclerosing cholangitis

These diseases affect the bile ducts and can lead to increased pressure in the portal system.

98
Q

What symptoms are associated with hepatic vein thrombosis in Budd-Chiari syndrome?

A

Pain and ascites

Budd-Chiari syndrome is characterized by obstruction of hepatic veins, leading to hepatic venous outflow obstruction.

99
Q

True or False: High IVC obstruction can lead to portal hypertension.

A

True

High inferior vena cava obstruction can result in increased pressure in the portal system.

100
Q

Fill in the blank: Portal vein thrombosis can be caused by _______.

A

umbilical catheter, omphalitis, or sepsis

These factors can increase the risk of thrombus formation in the portal vein.

101
Q

What is the significance of a hepatic vein thrombosis?

A

It can lead to Budd-Chiari syndrome and associated symptoms like pain and ascites

This condition can severely affect liver function and overall health.

102
Q

What are some post-sinusoidal causes of portal hypertension?

A

• Central vein thrombosis
• Veno-occlusive disease

These conditions occur after blood has passed through the liver.

103
Q

What is the role of polycythemia in portal vein thrombosis?

A

It can lead to dehydration and increased blood viscosity, contributing to thrombosis

Polycythemia is a condition where there is an increased number of red blood cells.

Hepatology (5 decks)

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