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SALMAN HARRISON'S > 337 - Cirrhosis and Its Complications > Flashcards

337 - Cirrhosis and Its Complications Flashcards

1
Q

Cirrhosis pathology includes ___ due to activation of ___ cell in the liver which produce ___- leading to changes in the liver’s ___ together with ___ formation, decrease in liver ___ and function, blood flow changes.

A 
Fibrosis 
Stellate
Architecture
Collagen 
Nodules
Mass
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2
Q

Liver cirrhosis can be classified into ___ and ___. The latter has a decrease in ___ and we should consider ___

A

Compensated
Uncompensated
Liver function
Liver transplantation

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3
Q

____ of liver cirrhosis represent the severity of the disease, while staging and grading are defined by ____.

A

Clinical symptoms

Biopsy

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4
Q

Hepatocellular injury may lead to: (4)

A
  1. Jaundice
  2. Hemostasis dysfunction
  3. Hypoalbuminemia
  4. Encephalopathy
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5
Q

In uncompensated liver cirrhosis we will see ___ which in turns leads to __ and ___ bleeding.

A

Portal HTN
Varices
Varices

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6
Q

What are the 3 enzyme systems metabolizing alcohol?

A

ADH
MEOS
Peroxisomal catalase

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7
Q

Alcohol consumption may lead to activation of___ that create fibrinogenic cytokines which promote ___ activation and excessive synthesis of __ and ___

A

Kupffer cells
Stellate
Collagen
ECM

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8
Q

Alcohol injury leads to the formation of connective tissue between the ____ to the main ___ and creates regenerative ___

A

Portal triad
Vein
Nodules

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9
Q

Alcohol cirrhosis is a process that progresses for ___ and leads to loss of ___ and decrease in ___ size

A

Years
Hepatocytes
Liver

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10
Q

Ethanol also increases the accumulation of ___ due to an increase in its ___, decrease in fatty acid ___ and damage in ____ secretion.

A

Triglycerides
Absorption
Oxidation
lipoproteins

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11
Q

General clinical symptoms of alcohol induced liver cirrhosis include: (5)

A
  1. Fever
  2. Anorexia
  3. RUQ dull pain
  4. Nausea/vomiting
  5. Diarrheas
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12
Q

Specific clinical symptoms of alcohol induced liver cirrhosis include: (5)

A
  1. Encephalopathy
  2. Jaundice
  3. Ascites
  4. GI bleeding
  5. Edema
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13
Q

Physical examination of a patient with alcohol induced liver cirrhosis include: (5)

A
  1. Parotid enlargement
  2. Palmar erythema
  3. Clubbing
  4. Spider angioma
  5. Edema/ascites
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14
Q

In men with alcohol induced liver cirrhosis we can see body___ loss, ___ and ___atrophy due to hormonal changes

A

Hair
Gynecomastia
Testicular

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15
Q

Lab results of alcohol induced liver cirrhosis may present: ANTI2 (5)

A
  1. Anemia
  2. Nutritional deficiency
  3. Thrombocytopenia
  4. Increased direct bilirubin
  5. Increased AST and ALT
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16
Q

Diagnosis of alcohol induced liver cirrhosis can be made with ____. Only __ months after rehabilitation another biopsy should be made to determine the severity of

A

Biopsy

6

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17
Q

The best treatment for alcohol induced liver cirrhosis is ___. Drugs that can be used include: (3)

A

Alcohol absenteeism
Absenteeism calcium
Glucocorticoids
N-acetylcysteine

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18
Q

After exposure to ____, ____ of patients will develop chronic hepatitis, of them ___ will continue to ____

A

HCV
80%
20-30%
Liver cirrhosis

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19
Q

After HBV exposure, ___ of patients will develop chronic hepatitis, of them ___ will continue to ___

A

5%
20%
Liver cirrhosis

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20
Q

In chronic HBV we will see positive ___ and ___, and possibly hepatocytes with ground glass appearance in imaging tests

A

HBc-Ag

HBs- Ag

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21
Q

Chronic HBV can be treated with ___, helping preventing the shift from _____ to uncompensated cirrhosis

A

Anti viral drugs

Compensated

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22
Q

Chronic HCV can be treated with the very expensive ___ protocol (95% cure rate) for a relative short period of ____ weeks

A

Anti viral

8-12

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23
Q

AIH stands for____. Diagnosis will require autoimmune markers such as: ___ and ___. If the patients are suffering from cirrhosis in tandem with active inflammation and elevated liver enzymes- treat with ___ drugs.

A

Auto immune Hepatitis
ANA
ASMA
Immunosuppressive

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24
Q

NAFLD stands for____. Most patients have ____

A

Non-alcoholic fatty liver disease

Steatohepatitis

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25
Q

Cholestatic disease can be ___ or ____. In the latter we can treat with ___ or ___.

A

Intrahepatic
Extrahepatic
Surgery
Endoscopy

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26
Q

The main etiologies for cholestatic disease are: (4)

A
  1. PBC (Primary biliary cholangitis)
  2. AIC (Auto immune cholangitis)
  3. PSC (Primary sclerosing cholangitis)
  4. Idiopathic
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27
Q

The cause leading to PBC is unknown. It is common in ___ over the age of ___. Characterized by ____ and __ together with ____ and ____

A 
Women
50
Portal inflammation
Necrosis of small/medium bile tubeless
Cholestatic characteristics
Elevated bilirubin
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28
Q

What is the recommended treatment for PBV patients with uncompensated liver cirrhosis? What can slow down the progression of the disease?

A

Liver transplantation

UDCA (ursodeoxycholic acid)

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29
Q

Most PBC patients will present ___ antibodies

A

AMA (Anti mitochondrial membrane antibodies)

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30
Q

Most PBC patients are diagnosed in the asymptomatic state with general symptoms including: (3)

A

Hepatosplenomegaly
Aseities
Edema

31
Q

Specific PBC symptoms include: (4)

A
  1. Fatigue
  2. Pruritus (mostly in the evenings)
  3. Cholesterol metabolism dysfunction
  4. Bone pain
32
Q

Lab results of PBC patients will include: (5)

A
  1. Cholestatic liver enzymes elevation (GGT,ALP,AST,ALT)
  2. Immunoglobulins elevation (IgM)
  3. Hyperbilirubinemia
  4. Pancytopenia
  5. AIH characteristics
33
Q

PBC treatment include ___ which is crucial to initiate ASAP. It does not lead to ___ and is ineffective once ___ symptoms start.

A

UDCA
Cure
Liver cirrhosis

34
Q

UDCA S/E include: (3)

A
  1. Pruritus
  2. Diarrhea
  3. Headache
35
Q

Once a PBC patient is in the ____ stage, consider ____

A

Uncompensated liver cirrhosis

Liver transplantation

36
Q

PSC (Primary sclerosing cholangitis) is characterized by ___ and ___ in the entire biliary tree (___ and ___) causing chronic cholestasis and eventually- ___

A

Chronic diffuse inflammation
Fibrosis
Intra and extra hepatic
Cirrhosis

37
Q

Clinical signs of PSC include: (5)

A
  1. Fatigue
  2. Pruritus
  3. Steatorrhea
  4. ADEK vitamin deficiency
  5. Metabolic bone deficiency
38
Q

Lab results of PSC will show an increase of X2 ___ and slight elevation in ___. Low ____ and elongated ____. ___ will be up to X5 above the upper limit.

A 
ALP
AST/ALT
Albumin
PTT
Aminotransferase
39
Q

In PSC ____ will be positive in 65% of patients. up to 50% will be diagnosed with ___ as well, therefore ___ is necessary when diagnosed

A

p-ANCA
UC
Colonoscopy

40
Q

In order to diagnose PSC ___ must be made, first with ___ followed by ___ in order to check for strictures.

A

Cholangiography imaging
MRCP
ERCP

41
Q

Typical findings of PSC imaging include ____ of the bile ducts. the ___ and ___ can be involved in 15% of casese

A

Beading
Cystic duct
Gallbladder

42
Q

There is no proved treatment for PSC. High dosage of ___ is harmful, but low dosage can be helpful. Additionally, endoscopy ___ can be beneficial . Definitive treatment is ____.

A

UDCA
dilatation
Liver transplantation

43
Q

Right side HF leading to increase pressure on the ___ and ___ may lead to ____

A

IVC
Hepatic ducts
Cirrhosis

44
Q

Mention 4 more types of liver cirrhosis:

A
  1. Hemochromatosis
  2. Wilson’s disease
  3. Alpha1 AT deficiency
  4. Cystic Fibrosis
45
Q

What are the steps in classification of portal hypertension?

A

Prehepatic->
Hepatic (presinusoidal, sinusoidal, postsinusoidal)->
Posthepatic->
Cardiac.

46
Q

The main complications of portal hypertension are ___, ____, ____, and ___

A

Esophageal varices
Ascites
Edema
Hypersplenism

47
Q

Bleeding varices is a ___ with mortality of ___ in each bleeding event.

A

Life threatening event

20-30%

48
Q

Screening tests is necessary in patients with liver cirrhosis because most of them will develop ___ in during their lifetime and __ of them will bleed.

A

Varices

1/3

49
Q

Risk factors for varices bleeding include: (5)

A
  1. Cirrhosis severity (Child’s Pugh/MELD)
  2. Ascites
  3. Wedge hepatic vein pressure
  4. Location and size
  5. Cherry red spots/white nipple spots
50
Q

If we diagnose varices which are prone to bleed in liver cirrhosis patient we can either administrate ___ or ___

A

Non selective Beta blockers

Variceal band ligation

51
Q

When varices are actively bleeding we must first ___. First line will be ___ or ___. Additionally we must administrate ___ and ___

A 
Stop the bleeding
Scleropathy  
Band ligation
Blood 
Fluids
52
Q

Further varices bleeding is prevented via additional ___ of the varices (EVL). To stop the bleeding, drugs such as ___ and ____. Other mechanical wats can be

A

Ligation
Somatostatin
Octreotide
Balloon

53
Q

When varices are persistent, consider TIPS (___). Of these patients, ___ will develop encephalopathy. This treatment could be a bridge before ____

A

Transjugular intrahepatic portosystemic shunt
20%
Liver transplantation

54
Q

SAAG above 1.1 g/dL suggests

A

Portal HTN

55
Q

SAAG under 1.1 g/dL suggests

A

Infection/malignancy

56
Q

In ascites there will be a low concentration of ___, usually < ___ g/dL. When very low there’s a risk for ___

A

Protein
1
SBP (spontaneous bacterial infection)

57
Q

In ascites with PMN>250-

A

Infected fluid

58
Q

In small ascites we can treat with ___ reduction (< __ ). Medium size- diuretics such as ____ and if needed add ___. If the ascites persists consider ___ or ___

A 
Salt
2 mg/day
Spironolactone 
Furosemide 
Drainage
TIPS
59
Q

What are the common pathogens leading to SBP? (4)

A
  1. E. Coli
  2. Strep Viridans
  3. Staph aureus
  4. Enterococcus
60
Q

What should we suspect when more than 2 pathogens are diagnosed in ascites fluid?

A

Peritoneal infection due to perforation

61
Q

What is the treatment for SBP?

A

3rd gen cephalosporin (ceftriaxone)

62
Q

What is hepatorenal syndrome?

A

Functional renal failure without renal pathology, caused by a disturbance in the arterial renal circulation.

63
Q

How do you diagnose hepatorenal syndrome?

A

A large ascites with gradual increase in Cr.

64
Q

What is type 1 hepatorenal syndrome?

A

Gradual damage in renal function and a drastic decrease in Cr clearance within 2 weeks

65
Q

What is type 2 hepatorenal syndrome?

A

Decrease in GFR and an increase in Cr clearance in a stable fashion- better prognosis

66
Q

What is the treatment for hepatorenal syndrome? (4)

A

Midodrine (Alpha agonist)
Octreotide
Albumin IV
Liver transplantation (best treatment)

67
Q

What is liver encephalopathy?

A

Mental state changes due to liver failure

68
Q

Usually in liver encephalopathy there will be high levels of ____, without direct correlation to the severity of the disease, therefore, ammonia is not part of the ___

A

Ammonia

Diagnosis

69
Q

Diagnosis is ___, with ___ being one of the signs.

A

Clinical

Asterixis

70
Q

In sever cases we can see ___, that may lead to ___. Therefore we should treat it with ___ and ___.

A

Brain edema
Herniation
Mannitol
Fluids IV

71
Q

Encephalopathy can appear within weeks to months and is usually preceded by ___, ___, ___ or ___.

A

Hypokalemia
Infection
Increase in protein consumption
Electrolytes disturbance

72
Q

The main treatment for encephalopathy is ___. It leads to ____ of the and prevents absorption of ____agents.

A

Lactulose
Acidification
Colon
Toxic

73
Q

Beside lactulose we can treat encephalopathy with: (2)

A

Rifaximin (unobservable Abx)

Zinc

SALMAN HARRISON'S (163 decks)

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