Complications of Liver Disease

Question 1

True or false: a biopsy of someone with hepatorenal syndrome will demonstrate thickened sub-epithelial membrane.

Answer 1

False. There are no structural effects in the kidneys of someone with hepatorenal syndrome.

Question 2

There are two types of hepatorenal syndrome. Which is more severe?

Answer 2

Type I

Question 3

What things are needed for a diagnosis of hepatorenal syndrome?

Answer 3

• portal hypertension
• creatinine greater than 1.5 mg/dl or clearance less than 40 ml/min
• absence of shock, bacterial infection, or nephrotoxic drugs
• absence of excessive GI or renal fluid loss
• no improvement in renal function after 1.5 l of fluid
• urinary protein less than 500 mg/dl
• ascites
• hyponatremia

Question 4

What is SBP?

Answer 4

Spontaneous bacterial peritonitis – the most common infection in cirrhotic patients

Question 5

An ascites PMN count greater than 250/mL indicates __________.

Answer 5

SBP

Question 6

The three most common organisms that cause SBP are _____________.

Answer 6

E. coli, Streptococcus and Klebsiella

Question 7

SBP frequently ___________.

Answer 7

recurs

Question 8

True or false: ammonia elevation is required for a diagnosis of hepatic encephalopathy.

Answer 8

False. Ammonia levels are notoriously unreliable.

Question 9

Lactulose helps treat hepatic encephalopathy by ___________.

Answer 9

acidifying the stool, which then absorbs NH3

Question 10

Why is HLA testing not needed for liver transplantation?

Answer 10

Because the liver is not immunologically active, so blood testing is the only requirement