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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
What are the investigations for hypoalbuminemia mentioned in IMG_1962.jpeg?
Investigations include serum albumin levels and liver function tests to assess liver synthetic function.
26
What is the main topic discussed in **IMG_1962.jpeg**?
The main topic is **Hematology**, focusing on **splenomegaly**, **portal hypertension**, and related clinical features.
27
What is **splenomegaly**, and what are its causes as mentioned in **IMG_1962.jpeg**?
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).
28
What are the clinical features of **portal hypertension** as described in **IMG_1962.jpeg**?
Clinical features include **dilated anterior abdominal wall veins (caput medusae)**, **ascites**, and **esophageal varices** which may lead to **hematemesis**.
29
What are the **prehepatic causes** of splenomegaly mentioned in **IMG_1962.jpeg**?
Prehepatic causes include **portal vein obstruction** and **splenic vein thrombosis**.
30
What are the **hepatic causes** of splenomegaly mentioned in **IMG_1962.jpeg**?
Hepatic causes include **hepatomegaly**, **mild to moderate splenomegaly**, and **shrunken liver** in advanced hepatic diseases.
31
What are the **posthepatic causes** of splenomegaly mentioned in **IMG_1962.jpeg**?
Posthepatic causes include **congested liver** and **mild splenomegaly** due to obstruction.
32
What is the significance of **caput medusae** in portal hypertension, as mentioned in **IMG_1962.jpeg**?
Caput medusae refers to **dilated veins around the umbilical region** and is a sign of **severe portal hypertension**.
33
What are the complications of **esophageal varices** mentioned in **IMG_1962.jpeg**?
Complications include **hematemesis** (vomiting of blood), which can be **mild or life-threatening**.
34
What is the clinical significance of **ascites** in advanced liver disease, as mentioned in **IMG_1962.jpeg**?
Ascites is a sign of **advanced liver disease** and is associated with **hypoalbuminemia** and **sodium retention**.
35
What are the **investigations** mentioned for diagnosing portal hypertension in **IMG_1962.jpeg**?
Investigations include **abdominal examination** for dilated veins, **ultrasound** for liver and spleen size, and **endoscopy** for esophageal varices.
36
What is the significance of **hematemesis** in portal hypertension, as mentioned in **IMG_1962.jpeg**?
Hematemesis is a **life-threatening complication** of esophageal varices and indicates **severe portal hypertension**.
37
What is the role of **hypoalbuminemia** in the development of ascites, as mentioned in **IMG_1962.jpeg**?
Hypoalbuminemia reduces **oncotic pressure**, leading to fluid accumulation in the abdominal cavity (ascites).
38
What are the **early signs** of portal hypertension mentioned in **IMG_1962.jpeg**?
Early signs include **splenomegaly** and **dilated abdominal wall veins**.
39
What is the significance of **organomegaly** in portal hypertension, as mentioned in **IMG_1962.jpeg**?
Organomegaly, particularly **splenomegaly**, is a key feature of portal hypertension and can indicate the underlying cause (prehepatic, hepatic, or posthepatic).
40
What is the clinical picture of **hematomas** in prolonged cases of portal hypertension, as mentioned in **IMG_1962.jpeg**?
In prolonged cases, hematomas from **esophageal varices** may occur, which can be **mild or life-threatening**.
41
What is the significance of **dilated veins around the umbilical region** in portal hypertension, as mentioned in **IMG_1962.jpeg**?
Dilated veins around the umbilical region, known as **caput medusae**, are a sign of **severe portal hypertension**.
42
What is the role of **sodium retention** in the development of ascites, as mentioned in **IMG_1962.jpeg**?
Sodium retention contributes to **fluid accumulation** in the abdominal cavity, leading to ascites.
43
What are the **advanced signs** of portal hypertension mentioned in **IMG_1962.jpeg**?
Advanced signs include **ascites**, **hematemesis**, and **hepatic encephalopathy**.
44
What is the significance of **shrunken liver** in advanced hepatic diseases, as mentioned in **IMG_1962.jpeg**?
A shrunken liver is a sign of **advanced hepatic disease** and is often associated with **cirrhosis**.
45
What is the clinical significance of **hyperglycemia** in prehepatic causes of splenomegaly, as mentioned in **IMG_1962.jpeg**?
Hyperglycemia may occur in prehepatic causes of splenomegaly and can lead to **pancytopenia**.
46
What is the significance of **congestive gastropathy** in portal hypertension, as mentioned in **IMG_1962.jpeg**?
Congestive gastropathy refers to **gastric mucosal changes** due to portal hypertension and can lead to **gastric bleeding**.
47
What is the role of **rectal hemorrhoids** in portal hypertension, as mentioned in **IMG_1962.jpeg**?
Rectal hemorrhoids are a complication of portal hypertension and can cause **bleeding**.
48
What is the procedure for inflating balloons in the treatment of internal hemorrhoids?
Balloons inflated through catheter in the nose
49
What is the primary function of sclerotherapy in the context of esophageal varices?
Sclerotherapy (ethanolamine oleate) or Ligation for esophageal varices
50
What is the significance of endoscopy in the treatment of esophageal varices?
Diagnostic & Therapeutic
51
Name one emergency surgical measure for treating pre hepatic thrombosis.
Surgical Porto-systemic shunt
52
What does TIPSS stand for?
Trans-jugular Intrahepatic Porto-systemic Shunt
53
What is a potential treatment option for end-stage liver disease?
Liver transplantation
54
What is a recommended strategy to prevent re-bleeding after the first attack?
Prophylactic Band ligation or sclerotherapy
55
Which medications are suggested for the prevention of re-bleeding after the first attack?
Propranolol (Beta blocker)
56
What are the treatment options after a second attack of esophageal varices?
* Beta adrenergic blockers (propranolol) * Endoscopic sclerotherapy or band ligation * Surgical porto-systemic shunt * Liver transplantation
57
Fill in the blank: The balloon catheter is used to _______ the tract.
dilate
58
True or False: Avoiding aspirin and NSAIDs is recommended after the first attack of varices.
True
59
What is the role of the inferior vena cava in the context of balloon catheter procedures?
Shunts blood from varices
60
What should be avoided during the treatment of varices to prevent complications?
Aspirin and NSAID
61
What is the purpose of using a guidewire during the procedure?
To assist in catheter placement
62
Fill in the blank: The portal vein is associated with _______ and varices.
decompressed
63
What are the laboratory findings for liver function tests in pre-hepatic causes?
Normal functions ## Footnote Pre-hepatic causes typically do not impair liver function tests.
64
What are the laboratory findings for liver function tests in hepatic causes?
Impaired functions ## Footnote Hepatic causes indicate a dysfunction of the liver.
65
What hematological findings might indicate bleeding or hypersplenism?
Anemia or pancytopenia ## Footnote Anemia suggests bleeding, while pancytopenia indicates hypersplenism.
66
What imaging technique assesses the patency and direction of flow in the portal vein?
Doppler flow ## Footnote Doppler flow studies are crucial for evaluating portal vein status.
67
What does ultrasonography evaluate in liver pathology?
Liver size, spleen, ascites ## Footnote Ultrasonography provides a non-invasive assessment of liver and spleen morphology.
68
What imaging methods are used to assess vessel patency?
CT angiography and MR Venography ## Footnote Both CT angiography and MR venography are advanced imaging techniques for vascular evaluation.
69
What is the role of a liver biopsy in the context of hepatic fibrosis?
Should be done after correction of coagulopathy ## Footnote Liver biopsy is invasive and requires careful management of coagulopathy.
70
What is the purpose of upper GIT endoscopy in liver disease?
Detection of esophageal varices or ulcers ## Footnote Endoscopy allows direct visualization and assessment of esophageal conditions.
71
What is the first step in the emergency treatment of bleeding varices?
ICU Hospitalization and first aid measures (ABC) ## Footnote Initial management focuses on stabilizing the patient.
72
What IV fluid is recommended for a shocked patient?
Saline 20 ml/kg ## Footnote IV fluids are critical for volume resuscitation in shock.
73
What is the recommended blood transfusion volume for managing bleeding?
10 - 20 ml/kg ## Footnote Blood transfusions help restore blood volume and improve oxygen carrying capacity.
74
What treatments are used to correct coagulopathy in bleeding varices?
Fresh frozen plasma, IV Vitamin K, and platelets ## Footnote These treatments are essential for managing coagulopathy during bleeding episodes.
75
What types of drugs are used to manage bleeding varices?
H2 receptor blockers or Proton Pump Inhibitors (PPI) ## Footnote These medications reduce gastric acid secretion, helping to prevent further erosion.
76
What is the function of vasopressin infusion in bleeding varices?
Decreases portal flow ## Footnote Vasopressin helps control bleeding by constricting splanchnic vessels.
77
What is the purpose of a naso-gastric tube in the context of bleeding varices?
For gastric wash and to monitor ongoing losses ## Footnote Naso-gastric tubes are crucial for managing gastrointestinal bleeding.
78
What is a compression tube used for in treating bleeding varices?
Mechanical compression for bleeding varices (not more than 48H) ## Footnote Compression tubes can help control bleeding but should be used with caution.
79
True or False: Compression tubes can be used indefinitely for bleeding varices.
False ## Footnote Compression tubes should not be used for more than 48 hours to avoid complications.
80
What is the primary cause of splenomegaly in hepatology?
Congestion of abdominal viscera drained by portal vein ## Footnote This occurs due to increased pressure in the portal venous system.
81
What are the consequences of portal hypertension related to blood flow?
Development of collaterals carrying blood from portal venous system to systemic circulation ## Footnote This can lead to various complications, including varices.
82
List three high-risk conditions associated with gastrointestinal bleeding due to portal hypertension.
* Esophageal varices * Gastric varices * Rectal hemorrhoids (Piles) ## Footnote These conditions arise from increased pressure in the portal system.
83
What is Caput Medusae?
Dilated veins around the umbilicus ## Footnote This is a visible sign of portal hypertension.
84
Which vein is associated with the development of collateral circulation in portal hypertension?
Azygos vein ## Footnote This vein can provide alternative pathways for blood flow.
85
What is hematemesis?
Vomiting blood ## Footnote This can occur as a result of bleeding from esophageal varices.
86
What does ascites indicate in advanced liver disease?
Hypoalbuminemia & sodium retention ## Footnote It is a common manifestation in patients with liver dysfunction.
87
What is a key prehepatic cause of splenomegaly?
Significant & early splenomegaly with normal liver function ## Footnote This can occur due to portal vein obstruction.
88
What condition may lead to pancytopenia in the context of splenomegaly?
Hypersplenism ## Footnote This condition results from an enlarged spleen sequestering blood cells.
89
What are the hepatic causes of splenomegaly?
* Hepatomegaly * Mild to Moderate Splenomegaly * Shrunken liver in advanced hepatic diseases ## Footnote These conditions reflect liver dysfunction and its effects on the spleen.
90
What is the clinical picture of hematemesis from esophageal varices?
May be the first manifestation; may be mild or massive life-threatening ## Footnote This can indicate severe portal hypertension and warrants immediate medical attention.
91
What examination findings are associated with advanced liver disease?
* Ascites * Organomegaly ## Footnote These findings are common in patients with significant liver dysfunction.
92
True or False: Markedly congested liver with no splenomegaly indicates supra-hepatic obstruction.
True ## Footnote This condition can occur early in the obstruction process.
93
What is the definition of portal hypertension?
Portal venous pressure more than 10-12 mm Hg (Normal: 5-10 mm Hg) ## Footnote Portal hypertension can lead to various complications and is often associated with liver disease.
94
What are pre-hepatic causes of portal hypertension?
• Portal vein thrombosis • Splenic vein thrombosis • Mesenteric vein thrombosis ## Footnote Pre-hepatic causes often involve blockages before blood reaches the liver.
95
What is the commonest cause of umbilical vein thrombosis?
Umbilical thrombophlebitis ## Footnote This condition can occur due to umbilical catheterization or infections such as omphalitis.
96
List some intra-hepatic causes of portal hypertension.
• Fibrosis • Hepatocellular disease • Congenital hepatic fibrosis • Chronic hepatitis • Cirrhosis • Veno-occlusive disease ## Footnote Intra-hepatic causes are related to conditions affecting the liver tissues directly.
97
What are examples of biliary tract diseases associated with portal hypertension?
• Biliary atresia (EHBA) • Cystic fibrosis • Sclerosing cholangitis ## Footnote These diseases affect the bile ducts and can lead to increased pressure in the portal system.
98
What symptoms are associated with hepatic vein thrombosis in Budd-Chiari syndrome?
Pain and ascites ## Footnote Budd-Chiari syndrome is characterized by obstruction of hepatic veins, leading to hepatic venous outflow obstruction.
99
True or False: High IVC obstruction can lead to portal hypertension.
True ## Footnote High inferior vena cava obstruction can result in increased pressure in the portal system.
100
Fill in the blank: Portal vein thrombosis can be caused by _______.
umbilical catheter, omphalitis, or sepsis ## Footnote These factors can increase the risk of thrombus formation in the portal vein.
101
What is the significance of a hepatic vein thrombosis?
It can lead to Budd-Chiari syndrome and associated symptoms like pain and ascites ## Footnote This condition can severely affect liver function and overall health.
102
What are some post-sinusoidal causes of portal hypertension?
• Central vein thrombosis • Veno-occlusive disease ## Footnote These conditions occur after blood has passed through the liver.
103
What is the role of polycythemia in portal vein thrombosis?
It can lead to dehydration and increased blood viscosity, contributing to thrombosis ## Footnote Polycythemia is a condition where there is an increased number of red blood cells.

Hepatology (5 decks)

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