Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

STEP 2 GI > UW revision cirrhosis > Flashcards

UW revision cirrhosis Flashcards

1
Q

Cirrhosis. Initial evaluation?

A

History taking: medications, social habits (alcohol, drugs use, high risk sexual activity), and family history (eg to exclude hemochromatosis).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Cirrhosis. Labs?

A

viral hepatitis serologies and iron studies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

How to distinguish cirrhosis?

A

Paracenthesis + SAAG calculation

can distinguish between portal hypertensive and non-portal hypertensive causes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Cirrhosis assoc. with shrunken liver and splenomegaly (congestion from portal hypertension) BUT hepatomegaly can occasionally be seen in early cirrhosis due to ongoing inflammation.

A

.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Other portal hypertensive ascites causes?

A

constrictive pericarditis, right sided heart failure.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

NONportal hypertensive ascites causes?

A

Nephrotic syndrome, peritoneal carcinomatosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

NONportal hypertensive ascites CP finding?

A

Jugular venous distension is expected (eg hepatojugular reflux)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

portal hypertensive ascites CP finding absent?

A

NO HEPATOJUGULAR REFLUX

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Nephrotic syndrome mechanisms?

A

Edema and ascites due to hypoalbuminemia.
NO INCREASED PRESSURE. Portal pressure is unaffected, therefore hepatosplenomegaly is not expected.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Ovarian cancer with peritoneal metastasis (ie carcinomatosis) causes ascites with what portal pressure?

A

ascites without portal hipertension.
THEREFORE no hepatosplenomegaly.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Evaluation of ascites scheme.
First step?

A

perform diagnostic paracentesis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Evaluation of ascites scheme.
perform diagnostic paracentesis –> next?

A

Calculate SAAB (serum albumin - ascites albumin)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Evaluation of ascites scheme.
perform diagnostic paracentesis –> calculate SAAB –> IF HIGH (>= 1,1) –> interpretation and causes? 4

A

ELEVATED PORTAL PRESSURE

Cirrhosis (most common)
HF
Portal vein thrombosis
Budd-Chiari syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Evaluation of ascites scheme.
perform diagnostic paracentesis –> calculate SAAB –> IF LOW (< 1,1) –> interpretation? what 2 groups?

A

Portal pressure is not elevated.
Peritoneal inflammation OR very low serum albumin.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Evaluation of ascites scheme.
perform diagnostic paracentesis –> calculate SAAB –> IF LOW (< 1,1) –> Portal pressure is not elevated –>
Peritoneal inflammation. 3?

A

Peritoneal malignancy
Tuberculosis
Pancreatitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Evaluation of ascites scheme.
perform diagnostic paracentesis –> calculate SAAB –> IF LOW (< 1,1) –> Portal pressure is not elevated –>
very low serum albumin. 1?

A

Nephrotic syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

3 groups of liver dysfunction that cirrhosis cause?

A

Synthetic
metabolic
excretory

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

3 groups of liver dysfunction that cirrhosis.
Synthetic. 3?

A

Production of clotting factors, cholesterol, proteins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

3 groups of liver dysfunction that cirrhosis.
Metabolic. 2?

A

Metabolism of drugs and corticosteroids, including detoxification

20
Q

3 groups of liver dysfunction that cirrhosis.
Excretory 1?

A

Bile excretion

21
Q

what 2 CP due to hyperestrinism? general

A

spider angiomas and palmar erythema.

22
Q

spider angiomas and palmar erythema mechanism?

A

Impaired hepatic metabolism of circulating estrogens, a process that begins in the cytochrome P450 system.
Circulating estrogens affect vascular wall dialtion.

23
Q

what 3 CP due to hyperestrinism? in men?

A

gynecomastia, loss of pubic hair, testicular atrophy.

24
Q

again. Ascites due to portal hypertension. 2?

A

cirrhosis, cardiac ascites

25
Q

again. Ascites due to non-portal hypertension. 4?

A

malignancy, pancreatitis, nephrotic syndrome, TBC

26
Q

Ascitic fluid characteristic table.
Gross appearance. Typical?

A

Typically straw-colored and clear

27
Q

Ascitic fluid characteristic table.
Gross appearance. Bloody?

A

Suggests trauma or malignancy

28
Q

Ascitic fluid characteristic table.
Gross appearance. Cloudy?

A

suggests infection

29
Q

Ascitic fluid characteristic table.
Gross appearance. milky?

A

Lymphatic disruption (chylous)

30
Q

Ascitic fluid characteristic table.
SAAG. >=1,1 indicates what and causes?

A

indicates portal hypertension.
Causes: cirrhosis, heart failure

31
Q

Ascitic fluid characteristic table.
SAAG. <1,1 indicates what and causes?

A

non-portal hypertension
Causes: malignancy, TBC, nephrotic syndrome

32
Q

Ascitic fluid characteristic table. total protein value?

A

<2,5 is consistent with cirrhosis or nephrotic syndrome

> =2,5 suggest right heart failure (hepatic congestion)

33
Q

Ascitic fluid characteristic table. cell count for SBP?

A

> = 250 neutrophils is diagnostic of SBP

34
Q

Management of ascites in cirrhosis table. Initial evaluation? 2

A

Imaging for confirmation (abdominal UG) = shrunken liver and ascites
[shoul be performed in all patients] Diagnostic paracentesis to confirm etiology and rule out infection: SAAG, cell count and differential, total protein

35
Q

Management of ascites in cirrhosis table. Medical therapy diuretics?

A

SPIRONOLACTONE WITH FUROSEMIDE

BOTH, not single

promotes natriuresis and prevents electrolyte disturbances

36
Q

Management of ascites in cirrhosis table. alco, food?

A

abstinence from alcohol
sodium restriction

37
Q

Management of ascites in cirrhosis table. what drugs avoid?

A

ACEI/ARB, NSAIDs

38
Q

Management of ascites in cirrhosis table. Refractory ascites. Tx 2?

A

Large volume paracenthesis
TIPS

39
Q

Why avoid only spironolactone in ascites?
Furosemide alone?

A

sometimes used in patients prone to hypokalemia

furosemide: alone less effective in this population and predisposes to electrolyte wasting

40
Q

fluid restriction in ascites to treat hypervolemic hyponatermia?

A

In hypoNa - okay.
If normal sodium - NOT RECOMMENDED.

41
Q

severe SBP complication?

A

paralytic ileus = decr. abdominal sounds and xray findings.

Xray – dilated loops of small and large bowel with air in the colon and rectum.

42
Q

Hepatic hydrothorax. Cp?

A

SOB, decr. sounds on auscultation, pleuritic chest pain, hypoxemia

43
Q

Hepatic hydrothorax. mechanism?

A

Transudative pleural effusions that are thought to occur due to small defects in the diaphragm.

44
Q

Hepatic hydrothorax. side?

A

on the right, because diaphragm is less muscular

45
Q

Hepatic hydrothorax. Dx?

A

Detect effusion = xray
other tests to rule out other causes: thoracenthesis, echocardiogram

46
Q

Hepatic hydrothorax. Tx?

A

definitive to cirrhosis. diuretics, salt restriction

thoracenthesis - if patient has prominent symptoms
NO chest tube - loss of fluid, electrolytes, proteins, renal failure

STEP 2 GI (32 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions