Cirrhosis

Question 1

Cirrhosis can cause hypothalamic-pituitary dysfunction and primary gonadal injury resulting in

Answer 1

Hypogonadism presenting with erectile dysfunction and testicular atrophy

Question 2

Cirrhosis associated with elevated circulating levels of estradiol resulting in

Answer 2

Gynecomastia
Telangiectasia
Palmar erythema
Testicular atrophy

Question 3

Cirrhosis impact of thyroid hormone levels?

Answer 3

Liver produces thyroid hormone binding proteins, lower levels of these leads to lower total T3 and T4 (but normal free T3 and T4, thus TSH levels normal)

Question 4

Weight status in cirrhosis

Answer 4

Can have net weight loss (despite volume overload (ascites, peripheral edema)) due to poor oral intake, malabsorption, and catabolic state

Question 5

Cirrhosis appearance

Answer 5

small, shrunken, burnt out liver due to chronic disease

Question 6

HY causes of cirrhosis are

Answer 6

alcoholism
HepB/C
Wilson disease, hemochromatosis
NASH
a1-antitrypsin deficiency

Question 7

LFTs in cirrhosis

Answer 7

“Burned out” means LFTs are normal or low – i.e., there is not transaminitis as with acute hepatitis

Question 8

Important labs in cirrhosis

Answer 8

USMLE likes ­increased PT and decreased clotting factor synthesis in cirrhotic patients.

Hyperammonemia occurs due to decreased urea cycle activity (normally occurs in liver). This can cause hepatic encephalopathy (confusion) and asterixis (“hepatic flap” of the hands).

Question 9

With cirrhosis, USMLE likes acute exacerbations of hyperammonemia caused by

Answer 9

GI bleeds, thus increased ­
ammonia absorption