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Flashcards in Cirrhosis Deck (41):
1

The histologic characterization of cirrhosis is ___________.

fibrosis with regenerative nodules

2

There are two kinds of cirrhosis: ________________.

- compensated: no complications
- uncompensated: complications (portal hypertension – leading to varices and ascites – and liver insufficiency – leading to encephalopathy and jaundice)

3

Hypertrophy of which liver lobe is indicative of cirrhosis?

The caudate

4

True or false: biopsy is needed for definitive diagnosis of cirrhosis.

False. Cirrhosis can be diagnosed on CT or by clinical features – even to the point of transplant list! Only do a biopsy if someone has chronic liver disease and no other manifestations of cirrhosis.

5

What five criteria are in the Child-Turcotte-Pugh scale?

- ascites
- encephalopathy
- bilirubin
- albumin
- PT/INR

6

The MELD scale includes which three serum values?

- creatinine
- bilirubin
- PT/INR

7

The most common cause of portal hypertension is ___________.

cirrhosis

8

Post-sinusoidal occlusion often results from what kind of medical intervention?

Myeloablative therapy (for cancer)

9

What two things happen in cirrhosis that leads to portal hypertension?

(1) Fibrosis leads to structural interference
(2) Destruction of endothelial cells leads to decreased NO release and subsequent increase in vasoconstriction (whereas in healthy tissue, increased flow would lead to increased NO release and subsequent vasodilation)

10

The definitive diagnostic test for cirrhosis is _____________.

hepatic venous pressure gradient (HVPG)

11

HVPG is normal in ____________ portal hypertension, while it will be elevated in ____________________ portal hypertension.

pre-hepatic, pre-sinusoidal, and post-hepatic; sinusoidal and post-sinusoidal

12

______________ esophageal varices are more likely to rupture.

Large (which increase the wall tension)

13

Esophageal varices can be treated with ____________.

endoscopic band ligation

14

There is a surgical treatment for cirrhosis that is analogous to drilling a hole through the liver. What is it?

Transjugular intrahepatic portosystemic shunt – connecting the hepatic portal vein to the hepatic vein.

15

What is the use of octreotide? (This is going to be on the exam!) "Give octreotide before calling the GI fellow."

It causes vasoconstriction in the splanchnic vasculature. This causes constriction of the stomach/esophageal veins, leading to temporary inhibition of bleeding.

16

The most common cause ascites is ___________.

cirrhosis (80%)

17

One of the things that induces sodium retention is _____________.

over dilation of the splanchnic vasculature (from portal hypertension)

18

After paracentesis, what calculation can be done to help diagnose ascites?

(serum albumin) – (ascites albumin)

If this is greater than 1.1, this is cirrhotic ascites. (This also correlates well with HVPG.)

19

______________ often presents earlier than hypoalbuminemia or prolonged INR in those with cirrhosis.

Thrombocytopenia (because of hypersplenism)

20

The CTP scale goes from 5 to 15. You need a score of at least _______ to be put on the transplant list.

7

21

MELD stands for ________________.

Model for End-stage Liver Disease

22

In cirrhosis, the site of increased resistance is ______________.

sinusoidal

23

List the sites which can cause portal hypertension and the most common cause of each.

- pre-hepatic: portal vein thrombosis
- pre-sinusoidal: Schistosomiasis
- sinusoidal: cirrhosis
- post-sinusoidal: veno-occlusive disease
- post-hepatic: Budd-Chiari or CHF

24

Normal HVPG is ________.

3 to 6 mmHg

25

In addition to inhibiting the release of gastrin and histamine, octreotide also ______________.

causes vasoconstriction

26

Up to half of the cases of SBP may be _______________.

asymptomatic

27

A SAAG greater than 1.1 indicates ___________, while a SAAG less than 1.1 indicates _____________.

that the ascites is due to portal hypertension; that the ascites is peritoneal in origin

28

The best initial treatment for ascites is _____________.

diuretics and salt-restriction diets, which counteract the body's pathologic retention of water and sodium in ascites

29

What does giving albumin to someone with ascites do?

It promotes plasma-volume expansion, which increases effective arterial volume.

30

What are the two types of hepatorenal syndrome?

1: rapidly progressive (doubling of creatinine in a two-week period); two-week mortality
2: slowly progressive; associated with refractory ascites; six-month mortality

31

Large-volume paracentesis can cause ___________.

hepatorenal syndrome

32

Liver transplantation can cure HRS if done within ____________.

4-6 weeks of onset

33

True or false: SBP can be caused by an intestinal abscess.

False. By definition, SBP does not have an identifiable cause and thus results only from gut leakage.

34

The diagnosis of SBP relies on _______________.

PMN count greater than 250 per mL

35

___________ has a high rate of recurrence.

SBP

36

True or false: ammonia levels help diagnose hepatic encephalopathy.

False. Ammonia levels are notoriously unreliable in hepatic encephalopathy.

37

Those with _____________ have first priority for liver transplant. After that, those with the highest _______ score do.

fulminant liver failure; MELD

38

In Colorado, you need a MELD score above ______ to receive a liver transplant.

30

39

_____________ is the most sensitive test for ascites.

Ultrasound

40

Cardiac ascites and cirrhotic ascites both have elevated SAAG. How can you test ascitic fluid to distinguish the two?

Cardiac ascites has more protein

41

What two criteria are absolutely needed for diagnosis of hepatorenal syndrome?

Ascites and hyponatremia

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