Cirrhosis and Complications (Quiz 3)

Question 1

what is cirrhosis

Answer 1

• normal architecture of liver replaced by hepatic nodules separated by fibrosis

Question 2

how does cirrhosis occur

Answer 2

• stellate cell activation leads to accumulation of scar

Question 3

what can also activate stellate cels

Answer 3

• Kupffer cells

Question 4

how does cirrhosis cause jaundice and scleral icterus

Answer 4

• liver can’t process bile

Question 5

how does cirrhosis cause pruritus

Answer 5

• bile pigments deposited in skin

Question 6

how does cirrhosis cause coagulopathy

Answer 6

• liver cannot produce clotting factors

Question 7

how does cirrhosis cause ascites and edema

Answer 7

• liver cannot make albumin

Question 8

_____________ is the root cause in many of the complications of cirrhosis

Answer 8

• portal hypertension

Question 9

normal portostystemic pressure gradient is ______ mmHg

clinical symptoms of portal hypertension seen when gradient exceeds ________ mmHg

Answer 9

• 5

- 12

Question 10

what two things is portal pressure related to

Answer 10

• venous inflow

- resistance to outflow

Question 11

portal venous inflow is controlled by the tone of __________

Answer 11

• mesenteric arterioles

Question 12

in normal portal circulation, blood flows from _________ to the ________ circulation and then, back to the _______ circulation

Answer 12

• mesenteric arterioles
• portal venous circulation
• systemic venous circulation

Question 13

what is the inflow in portal hypertension

Answer 13

• increased due to mesenteric arteriolar dilation

Question 14

what is the outflow in portal hypertension

Answer 14

• elevated resistance through cirrhotic hepatic sinusoids

Question 15

once a patient develops complications of cirrhosis they have __________ disease

Answer 15

• decompensated

Question 16

what is the most devastating complication of cirrhosis and portal hypertension

Answer 16

• variceal hemorrhage

Question 17

what is the most common variceal hemorrhage

Answer 17

• esophageal varices

Question 18

treatment of variceal hemorrhage

Answer 18

• ligation banding

- TIPS

Question 19

to prevent variceal hemorrhage, all patients with cirrhosis need a screening

Answer 19

• EGD

Question 20

what medications can reduce portal hypertension

Answer 20

• non selective beta blockers

Question 21

procedure for gastric varices management

Answer 21

• BORTO

Question 22

how do we grade ascites

Answer 22

• serum-ascites albumin gradient (SAAG)

Question 23

diet changes for ascites treatment

Answer 23

• low sodium

Question 24

medications for ascites treatment

Answer 24

• duretics

Question 25

what does the TIPS procedure do purpose

Answer 25

- place shunt between hepatic veins and portal vein | - reduce portal hypertension

Question 26

spontaneous bacterial peritonitis caused by

Answer 26

- bacterial translocation from gut | - E. coli

Question 27

what do you see in peritoneal fluid with spontaneous bacterial peritonitis

Answer 27

> 250 PMNs

Question 28

what medication do you treat spontaneous bacterial peritonitis with

Answer 28

- 3rd generation cephalosporin

Question 29

what is hepatorenal syndrome what happens

Answer 29

- acute renal failure in a patient with cirrhosis | - reduced perfusion of kidneys

Question 30

which hepatorenal syndrome has a 50% reduction of plasma creatinine clearance to a level below 20 mL/min or doubling of serum creatinine in less than 2 weeks and is rapidly fatal

Answer 30

- type I

Question 31

which hepatorenal syndrome has a more indolent course and is primarily characterized by diuretics refractory ascites

Answer 31

- type II

Question 32

best treatment for hepatorenal syndrome

Answer 32

- liver transplant

Question 33

what is the most important etiologic factor worldwide for hepatocellular carcinoma

Answer 33

- hep B

Question 34

how to diagnose hepatocellular carcinoma

Answer 34

- alpha feto protein > 200 | - MRI

Question 35

what is hepatic encephalopathy

Answer 35

- disturbance in CNS function due to hepatic insufficiency

Question 36

what is the characterized neurotoxin in hepatic encephalopathy

Answer 36

- ammonia

Question 37

criteria for hepatic encephalopathy

Answer 37

- west haven criteria

Question 38

for liver transplantation, patient are listed according to the severity of their ______ score

Answer 38

- MELD-Na