Cirrhosis

Question 1

what causes cirrhosis?

Answer 1

hepatocellular injury with fibrosis and regenerative nodules

Question 2

cirrhotic changes that occur without major clinical impact

Answer 2

compensated

Question 3

cirrhosis that occurs with varices

Answer 3

compensated with varices

Question 4

cirrhosis that includes ascites, encephalopathy, jaundice, variceal bleeding and impaired bleeding control

Answer 4

decompensated cirrhosis

Question 5

what are 4 symptoms of cirrhosis?

Answer 5

fatigue
disturbed sleep
muscle cramps
weight loss

Question 6

what are 3 symptoms of advanced cirrhosis?

Answer 6

N/V
anorexia
abdominal pain (hepatomegaly or ascites)

Question 7

what will labs be in cirrhosis? AST/ALT, alk phos, bilirubin, albumin, PT/INR?

Answer 7

elevated AST/ALT
elevated alk phos
elevated bilirubin
decreased albumin
prolonged PT/INR

Question 8

what is the 1st line imaging study for diagnosing cirrhosis?

Answer 8

abdominal US

Question 9

what signs will point us to suspect cirrhosis? (2)

Answer 9

edema
venous dilation

(signs of chronic liver disease)

Question 10

what is the clinical gold standard for cirrhosis diagnosis?

Answer 10

liver biopsy

Question 11

when would a liver biopsy be needed?

Answer 11

is ultrasound is inconclusive

Question 12

what is the curative treatment for cirrhosis?

Answer 12

liver transplant

Question 13

what is patient education for the treatment of cirrhosis? (3)

Answer 13

no alcohol/hepatotoxins
low protein diet
vaccines (hep a, hep b, pneumovac, flu)

Question 14

what is recommended for patients with cirrhosis for prophylaxis of variceal bleeding?

Answer 14

propranolol

Question 15

what can be used to manage volume overload in patients with cirrhosis? (2)

Answer 15

sodium restriction
diuretics

Question 16

where are the sites of collateral circulation due to portal hypertension (complication of cirrhosis)? (5)

Answer 16

distal 1/3 esophagus
umbilical region
rectum
retroperitoneal space
outside surface of liver

Question 17

how does portal hypertension (cirrhosis complication) lead to hepatic encephalopathy?

Answer 17

shunting of blood with toxins from intestines around liver

Question 18

why does hepatorenal syndrome (cirrhosis complication) occur?

Answer 18

due to kidney injury or worsening chronic kidney dysfunction

Question 19

what is hepatorenal syndrome, due to cirrhosis, usually precipitated by?

Answer 19

acute decrease in cardiac output

Question 20

what is the treatment for hepatorenal syndrome caused by cirrhosis? (3)

Answer 20

D/C diuretics
IV albumin (increases oncotic pressure)
peripheral vasoconstriction x 7-14 days

Question 21

impaired CNS function due to high levels of ammonia absorbed from the intestines and bypass normal detoxification by the liver

Answer 21

hepatic encephalopathy (due to cirrhosis)

Question 22

what is the most common cause of hepatic encephalopathy (cirrhosis complication)?

Answer 22

increased protein in diet

Question 23

what should we look for in patients with hepatic encephalopathy (due to cirrhosis)?

Answer 23

upper GI bleed

Question 24

what is the treatment for hepatic encephalopathy? (2)

Answer 24

lactulose
rifaxamin (decreases ammonia producing intestinal flora)