Cirrhosis and Liver Disease Part I (exam 3)

Question 1

damage of the liver results in

Answer 1

development of nodules surrounded by fibrous bands –> cirrhosis

Question 2

complications of cirrhosis

Answer 2

impaired hepatocyte function
portal HTN
hepatocellular carcinoma
acute vatical bleeding
spontaneous bacterial peritonitis
ascites
hepatic encephalopathy

Question 3

cirrhosis is

Answer 3

irrversible

Question 4

biggest causes of cirrhosis

Answer 4

alcoholism
hepatitis c
nonalcoholic fatty liver disease

Question 5

the livers blood supply is mostly

Answer 5

venous

Question 6

blood enters the liver via

Answer 6

portal triad (portal vein, hepatic artery, bile ducts)

Question 7

portal vein

Answer 7

80% of livers blood supply
oxygen poor, nutrient rich
blood from GI and spleen

Question 8

hepatic artery

Answer 8

20% of livers blood supply
oxygen rich, nutrient poor
blood from heart

Question 9

liver functions

Answer 9

detoxification and clearance
metabolism
storage functions
formation and secretion of bile

Question 10

metabolism in the liver

Answer 10

carbohydrates, fat and protein metabolism

Question 11

clearance/detoxification in the liver

Answer 11

detoxification of drugs and poisons via phase I and II
traps bacteria

Question 12

storage functions of the liver

Answer 12

uptake and storage of vitamins A, D, B12 and folate

Question 13

bile formation and secretion in the liver

Answer 13

involved in digestion and absorption of fats
major route of excretion of lipid-soluble waste products

Question 14

what is activated in the liver that leads to fibrotic scar tissue

Answer 14

hepatic stellate cells

Question 15

fibrosis leads to decreased __________________ which alters portal blood flow

Answer 15

hepatocellular mass and function

Question 16

portal hypertension

Answer 16

high BP within the portal venous system

Question 17

portal hypertension is due to ________ which causes blood to ________________

Answer 17

fibrosis

back up in the portal vein

Question 18

hepatic venous pressure gradient is the pressure gradient between

Answer 18

portal and central venous pressures

Question 19

Normal HVPG

Answer 19

1-5 mm Hg

Question 20

portal HTN HVPG

Answer 20

over 5 mm Hg

Question 21

HVPG for risk for esophageal varices

Answer 21

greater than or equal to 10 mm Hg

Question 22

HVPG for risk for variceal bleeding and ascites

Answer 22

greater than or equal to 12 mm Hg

Question 23

varices

Answer 23

fragile blood vessels that may break and bleed

Question 24

under high HVPG, varices _______________________ which causes bleeding

Answer 24

stretch, swell, twist and break

Question 25

patients with variceal bleeding may present with

Answer 25

bloody vomiting black, loose stools

Question 26

ascites

Answer 26

accumulation of excess fluid within the abdomen

Question 27

signs and symptoms of ascites

Answer 27

increased abdominal girth and peripheral edema SOB malnourished muscle wasting weakness and fatigue

Question 28

hepatic encephalopathy

Answer 28

reversible, metabolically induced disturbance of the brain

Question 29

hepatic encephalopathy is caused by

Answer 29

accumulation of ammonia which interferes with brain function

Question 30

patients with hepatic encephalopathy present with

Answer 30

neglect of appearance forgetfulness difficulty concentrating confusion unresponsiveness coma

Question 31

true liver function tests include

Answer 31

hypoalbuminemia increased prothrombin time and INR

Question 32

true liver function tests reflects

Answer 32

decreased hepatic synthesis activity

Question 33

thrombocytopenia causes (in liver tests)

Answer 33

splenomegaly --> platelet destruction decrease in thrombopoietin production in the liver --> less platelets made immune destruction of platelets

Question 34

abnormalities seen in liver disease

Answer 34

hypoalbuminemia increased prothrombin time and INR thrombocytopenia increased aminotransferase levels increased bilirubin increased alkaline phosphatase and GGT

Question 35

which liver function abnormality are markers of hepatocyte injury?

Answer 35

increased aminotransferase levels

Question 36

aminotransferase leveis may or may not be elevated in

Answer 36

chronic liver disease

Question 37

increased bilirubin means loss of

Answer 37

liver excretory capacity

Question 38

what liver test reflects liver injury?

Answer 38

increased alkaline phosphatase and GGT

Question 39

alkaline phosphatase and GGT is typically elevated in

Answer 39

liver disease with bile flow obstruction

Question 40

elevated GGT or AST/ALT ratio suggests

Answer 40

alcohol intake

Question 41

what diagnostic test is the first approach? why?

Answer 41

ultrasound no radiation exposure/IV contrast, low cost

Question 42

ultrasound detects

Answer 42

nodularity, irregularity, atrophy, ascites

Question 43

CT/MRI detects

Answer 43

nodularity, atrophy, hypertrophy, ascites, varices

Question 44

EGD is the gold standard for

Answer 44

diagnosing varices

Question 45

Liver biopsy is golden standard for

Answer 45

diagnosing cirrhosis

Question 46

MELD (model for end stage liver disease)

Answer 46

omits ascites and encephalopathy includes additional lab markers (SCr, INR)

Question 47

Child-Pugh components

Answer 47

total bilirubin albumin ascites encephalopathy prothrombin time prolongation

Question 48

__________________ for liver impairments are based on Child-Pugh score

Answer 48

drug dose adjustments

Question 49

Child-Pugh A

Answer 49

no dosage adjustment necessary

Question 50

Child-Pugh B

Answer 50

use only if benefit outweighs likely risk

Question 51

Child-Pugh C

Answer 51

consider alternative agent

Question 52

compensated cirrhosis

Answer 52

no over clinical complications are present

Question 53

decompensated cirrhosis

Answer 53

complications present

Question 54

clinical presentation of cirrhosis

Answer 54

asymptomatic hepatomegaly splenomegaly pruritis jaundice spider angioma gynecomastia reduced libido palmar erythema anorexia weakness

Question 55

clinical presentation of decompensated cirrhosis

Answer 55

ascites spontaneous bacterial peritonitis variceal bleeding hepatic encephalopathy coagulation defects