The syndromes of cirrhosis

Question 1

Presinusoidal

Answer 1

Schistosomiasis, or non-cirrhotic portal hypertension

Question 2

Postsinusoidal

Answer 2

Cirrhosis, alcoholic hepatitis, congenital hepatic fibrosis

Question 3

Schistosomiasis, or non-cirrhotic portal hypertension

Answer 3

Presinusoidal

Question 4

Cirrhosis, alcoholic hepatitis, congenital hepatic fibrosis

Answer 4

Post sinusoidal

Question 5

Commonest causes of cirrhosis?

Answer 5

Alcohol
HCV
NASH (NAFLD)

Question 6

Compensated cirrhosis signs?

Answer 6

Spider naevi
Plamar erythema
clubbing
gynaecomastia
Hepatomegaly(?)
Spleenomegaly
NONE

Question 7

Decompensated cirrhosis signs?

Answer 7

Jaundice
Ascites
Encephalopathy
Brusing

Question 8

Complications of cirrhosis?

Answer 8

Ascites
Encephalopathy
Variceal bleeding
Liver failure

Question 9

Nutrition in cirrhosis?

Answer 9

An energy intake of 35-40 kcal/kg and a protein intake of 1.2-1.5g/kg are recommended.
Small frequent meals and snacks should be encouraged as this reduces fasting gluconeogenesis and muscle catabolism
NB rapid switch to catabolism, beware fasting eg over night.

Question 10

WHICH VITAMIN SHOULD YOU GIVE TO ALCOHOLICS???

Answer 10

Vitamin B supplementation thiamine MANDATORY in excess alcohol intake

Question 11

Osteoporosis and osteomalacia in cirrhosis, how would you treat?

Answer 11

Osteoporosis and osteomalacia are common complications. Supplement with 1000mg calcium and 20µg vitamin D per day

Question 12

Fat soluble vitamin deficiency may occur in..?

Answer 12

PSC and PBC. Monitor levels and supplement if necessary.

Question 13

What does ascites look like on ultrasound?

Answer 13

Dark

Question 14

Treatment for ascites

Answer 14

Improve underlying liver disease
Look for and treat infection-SBP (spontaneous
Drugs No NSAIDS, if iv think of sodium load
Reduce salt intake, maintain