Case: DECOMPENSATED LIVER DISEASE

Question 1

Causes of Abdominal Distension
🧠⚡6F⚡

Question 2

How to differentiate that Abdominal Distension is DUE TO: Fluid?

Answer 2

1. Diffuse
2. Changes with Position

Question 3

Causes of ASCITES

Answer 3

CVS
➡️ 1. Right Heart Failure
Liver disease
➡️ Portal HYPERTENSION
Renal
➡️ Nephrotic Syndrome
➡️ Chronic Kidney Disease
Malnutrition
Peritoneal Causes
➡️ Peritonitis
➡️ TB
GI
➡️ Protein losing enteropathy
➡️ Malabsorption syndrome

Question 4

Ascites ➕ Pedal Edema causes
🧠⚡ All Causes except Peritoneal causes ⚡
🧠⚡ Same as Anasarca⚡

Answer 4

1. Nephrotic Syndrome
2. Rt Heart Failure
3. Liver causes
4. Malabsorption

Question 5

Anasarca

Answer 5

Generalized Edema
➕
Serosal Cavities
✨ Pericardial
✨ Pleural
✨ Peritoneal

Question 6

Thiamine deficiency causes ANASARCA

Question 7

What does DECOMPENSATION mean in Cirrhosis

Answer 7

Presence of new Onset:
1. Hepatic Encephalopathy
2. Jaundice
3. Ascites (DUE TO: Portal HYPERTENSION)
4. GI Bleed

Question 8

Type of Jaundice in Cirrhotic Patient

Answer 8

Hepatocellular Jaundice

Question 9

Hemolytic JAUNDICE
Supporting Features

Answer 9

1. Itching ⛔
2. NORMAL Color stools
3. High Coloured Urine (Becomes Clear on Jaundice)

Question 10

Obstructive JAUNDICE
Supporting Features

Answer 10

1. Clay Coloured Stools
2. Itching ➕

Question 11

Why Obstructive Jaundice causes itching?

Answer 11

Bile Salts ⬆️ ⬆️
⬇️
Emulsify or saponify the Myelin sheath
⬇️
Nerve Ends gets Exposed
⬇️
Stimulated ➡️ Itching sensation

Question 12

Cause of Acute Onset Hepatocellular Jaundice

Answer 12

✨ HEPATITIS
Viral, Toxins, Alcoholism

Question 13

Cause of FEVER in Cirrhosis

Answer 13

1. Spontaneous Bacterial Peritonitis
2. Hepatitis
3. Infections
4. Malignancy ➡️ Hepatocellular CARCINOMA HCC

Question 14

Can Cirrhosis patient have FEVER without any cause?

Answer 14

Yes
TNF & Other Cytokine metabolism is disturbed in the liver
⬇️
Fever

Question 15

Altered Sleep Wake Cycle is a feature of

Answer 15

All ENCEPHALOPATHIES
✨ Uremic
✨ CO2
✨ Hepatic

Question 16

Precipitating factors for HEPATIC ENCEPHALOPATHY

Answer 16

1. GI Bleeding
2. Constipation
3. INFECTIONS & Sepsis
4. Dehydration
5. Metabolic abnormalities
   ✨ Hypokalemia
   ✨ Hyponatremia
   ✨ Metabolic Alkalosis
6. Renal Failure
7. HIGH PROTEIN DIET

Question 17

How COVID 19 can cause HEPATITIS?

Answer 17

1. Macrophage Activation Syndrome ➡️ Hepatitis
2. Drugs used for treating Covid 19
   ✨ Paracetamol
   ✨ Dexamethasone

Question 18

Portal HYPERTENSION cannot be diagnosed without

Answer 18

GI Bleeding

Question 19

⚡⚡ MOST COMMON CAUSE of CIRRHOSIS in INDIA & WORLD

Answer 19

HEPATITIS C infection > Alcoholic Liver disease

Question 20

Why important to know HCV is ⚡⚡ MOST Important cause of Cirrhosis

Answer 20

1. Preventable & Treatable
2. Further Complications like HCC predictable
3. Transmission to others possible

Question 21

Recurrent Jaundice in Young
Cause

Answer 21

Viral HEPATITIS

Question 22

⚡⚡ MOST COMMON CAUSE of CIRRHOSIS IN YOUNG

Answer 22

Wilson’s disease

Question 23

Is Jaundice a Feature of CIRRHOSIS

Answer 23

⭐ NO
Can be present only if
✨ Hepatitis in the regenerating nodules
✨ HCC

Question 24

Cause of Pitting Edema in Cirrhosis

Answer 24

2° HYPERALDOSTERONISM

Cause: Intravascular Hypovolemia DUE TO: Splanchnic Vasodilation in CIRRHOSIS
⬇️
RAAS Activation

Question 25

Cause of Cyanosis in CIRRHOSIS

Answer 25

1. Hepatopulmonary syndrome 2. Pleural Effusion

Question 26

Platypnea is a characteristic feature of

Answer 26

Hepatopulmonary Syndrome

Question 27

Causes of CLUBBING in Cirrhosis

Answer 27

1. 1° Biliary Cirrhosis 2. HCC

Question 28

Why Hair is space in CIRRHOSIS ?

Answer 28

Protein deficiency ➡️ Hair sparcity

Question 29

Which Hairs Growth are affected by Estrogen & Testesterone

Answer 29

Axillary & Pubic Hair

Question 30

Hair Complaint showing Estrogen predominant in Liver CIRRHOSIS

Answer 30

⬇️ shaving Frequency

Question 31

Low BP in Cirrhosis

Answer 31

1. Sepsis 2. Upper GI Bleed

Question 32

Signs of CIRRHOSIS specifically caused by ALCOHOL

Answer 32

1. Parotid Enlargement & Lacrimal Gland Enlargement 2. Dupuytren's contracture

Question 33

Cause of Palmar Erythema

Answer 33

Peripheral Vasodilation DUE TO: ⬆️⬆️ Estrogen / Androgen ratio

Question 34

How to differentiate Palmar Erythema of Polycythemia & Liver CIRRHOSIS

Answer 34

In Liver Cirrhosis: Only Thenar & Hypothenar redness & Central sparing ⬇️ Why? ⬇️ Anatomical distributor of blood vessels ⭐ In Polycythemia ➡️ Entire Palm is red

Question 35

Paper Money Skin

Answer 35

Numerous small vessels scattered randomly through the skin ln upper Arma

Question 36

How to clinically demonstrate Spider Nevi?

Answer 36

Apply pressure over Body of spider with GLASS SLIDE (Diascopy) ⬇️ Blanching ⬇️ Refilling after release of pressure

Question 37

Difference BETWEEN Venous Star & Spider Nevi?

Answer 37

1. Blood flow OPPOSITE to that of Spider nevi 2. Bluish coloured 3. Pattern, shape & size VARIABLE 4. ➕ on Dorsum of foot, around ankle, lower leg 5. Composed of Dilated Veins

Question 38

Patients with Spider Nevi with size > 15 mm

Answer 38

80% chances of Variceal Bleeds Hepatic Fibrosis ⬆️ Mortality ⬆️

Question 39

Causes of Pseudogynecomastia

Answer 39

1. Obesity 2. Cushing Syndrome

Question 40

Young ♂️ with Gynecomastia, always rule out

Answer 40

Testicular Tumors

Question 41

Flapping Tremors vs Tremors

Answer 41

Flapping Tremors 🎯One way Jerking movement 🎯 Negative Myoclonus Tremors 🎯 To & Fro movement

Question 42

Cause of Astirixis

Answer 42

Reticular Activating System ⛔ ⬇️ Momentarily Loss of Joint sense & Position