CLD

Question 1

Q: What is cirrhosis? A: Cirrhosis is diffuse hepatic fibrosis with the replacement of normal liver architecture by regenerative nodules

Answer 1

leading to decreased hepatocellular mass and altered blood flow.

Question 2

Q: What are the major types of liver cells? A: Hepatocytes

Answer 2

Kupffer cells

Question 3

Q: What is the global prevalence of compensated cirrhosis as of 2017? A: 1

Answer 3

395.0 per 100

Question 4

Q: What are the leading causes of cirrhosis globally?A: HBV

Answer 4

HCV

Question 5

Q: What cytokines are involved in the pathogenesis of cirrhosis? A: PDGF

Answer 5

TGF-β

Question 6

Q: What are the clinical manifestations of cirrhosis? A: Symptoms range from being asymptomatic to nonspecific symptoms (e.g.

Answer 6

fatigue

Question 7

Q: What nail changes can indicate cirrhosis? A: Muehrcke’s nails and Terry’s nails.

Question 8

Q: What is fetor hepaticus? A: A sweet

Answer 8

pungent smell of the breath caused by increased dimethyl sulfide concentrations in cirrhosis patients.

Question 9

Q: What is the gold standard for diagnosing cirrhosis? A: Liver biopsy.

Question 10

Q: What is the sensitivity and specificity of abdominal ultrasound for cirrhosis diagnosis? A: Sensitivity: 91%

Answer 10

Specificity: 94%.

Question 11

What is cirrhosis?

Answer 11

Cirrhosis is diffuse hepatic fibrosis with the replacement of the normal liver architecture by regenerative nodules.

It is the final pathway for a wide variety of chronic liver diseases.

Question 12

What are the key complications of cirrhosis?

Answer 12

• Portal hypertension
• Ascites
• SBP
• Variceal bleeding
• Hepatic encephalopathy

Question 13

What percentage of patients with cirrhosis worldwide had HBV in 2021?

Answer 13

42%

Question 14

What is the epidemiological trend regarding cirrhosis-related deaths from 2017 to 2019?

Answer 14

Cirrhosis caused 1.48 million deaths worldwide in 2019, an increase of 8.1% from 2017.

Question 15

What is the normal function of hepatocytes?

Answer 15

Hepatocytes account for 2/3 of the organ mass.

Question 16

What does portal hypertension lead to?

Answer 16

It leads to alterations in blood flow and complications such as ascites and variceal bleeding.

Question 17

What are the common symptoms of cirrhosis?

Answer 17

• Anorexia
• Weight loss
• Weakness
• Fatigue
• Fever
• Pruritis
• Muscle cramps
• Amenorrhea
• Impotence

Question 18

What is the significance of Muehrcke’s nails?

Answer 18

They are associated with cirrhosis and reflect underlying liver disease.

Question 19

What is the Child-Pugh classification used for?

Answer 19

To assess survival in patients with cirrhosis not undergoing surgery.

Question 20

What is ascites?

Answer 20

Ascites is the pathologic accumulation of fluid in the peritoneal cavity.

Question 21

True or False: Ascites is usually the first decompensation feature of patients with cirrhosis.

Answer 21

True

Question 22

What is the recommended dietary sodium restriction for managing Grade 2 ascites?

Answer 22

Restrict sodium intake to 88 mEq (2000 mg) per day.

Question 23

What are the major benefits of treating ascites?

Answer 23

• Relieves abdominal discomfort
• Improves quality of life
• Protects against SBP

Question 24

What is the risk associated with variceal hemorrhage in patients with cirrhosis?

Answer 24

Each episode of active variceal hemorrhage is associated with up to 20% mortality.

Question 25

What diagnostic methods are used to assess cirrhosis?

Answer 25

* Noninvasive (serologic or radiologic) * Invasive methods (liver biopsy)

Question 26

What does HVPG stand for?

Answer 26

Hepatic vein pressure gradient.

Question 27

What is the main cause of mortality in decompensated cirrhosis?

Answer 27

Complications of portal hypertension, HCC, and sepsis.

Question 28

Fill in the blank: The major goals of managing patients with cirrhosis include _______.

Answer 28

[Slowing or reversing the progression of liver disease, Preventing superimposed insults to the liver, Identifying medications that require dose adjustments or should be avoided entirely, Preventing, identifying, and treating the complications of cirrhosis, Determining the appropriateness and optimal timing for liver transplantation]

Question 29

What is the gold standard for diagnosing cirrhosis?

Answer 29

Liver biopsy.

Question 30

What is the significance of a HVPG greater than 12 mmHg?

Answer 30

It indicates a high risk of variceal bleeding.

Question 31

What is the role of ascitic fluid analysis?

Answer 31

Essential for detecting ascitic fluid infection and excluding causes of ascites other than cirrhosis.

Question 32

What is fetor hepaticus?

Answer 32

A sweet, pungent smell of the breath of a patient with cirrhosis caused by increased concentrations of dimethyl sulfide.

Question 33

What is the typical survival rate for patients with Child-Pugh class A cirrhosis after one year?

Answer 33

Approximately 100%.

Question 34

What is the annual rate of decompensation for patients with HBV-related cirrhosis?

Answer 34

10%.

Question 35

What are the clinical features of hepatic encephalopathy?

Answer 35

Altered mental status, confusion, and neurological signs.

Question 36

What is the relationship between ascites and the risk of developing other complications?

Answer 36

Ascites increases the risk of developing SBP, hyponatremia, and AKI.

Question 37

What are the primary sites for the development of varices?

Answer 37

Distal esophagus, stomach, rectum

Question 38

Where are esophageal varices most likely to rupture and bleed?

Answer 38

At the gastroesophageal junction

Question 39

What is the main purpose of varice formation?

Answer 39

To decompress the hypertensive portal vein and return blood to the systemic circulation

Question 40

What is the HVPG threshold at which esophageal varices develop?

Answer 40

At least 10 mmHg

Question 41

What HVPG level is associated with an increased risk of bleeding from esophageal varices?

Answer 41

≥12 mmHg

Question 42

What causes variceal hemorrhages?

Answer 42

Rupture of the variceal wall due to excessive wall tension

Question 43

What is the most commonly used method for detecting varices?

Answer 43

EGD (Esophagogastroduodenoscopy)

Question 44

What grading system is used for EGD grading of varices?

Answer 44

Japanese Research Society for Portal Hypertension

Question 45

What are the predictive factors for bleeding from varices?

Answer 45

* Location of varices * Size of varices * Appearance of varices * Clinical features of the patient * Variceal pressure

Question 46

What is the definition of small varices in terms of diameter?

Answer 46

5 mm or less in diameter

Question 47

What is the risk of bleeding from small varices by 2 years?

Answer 47

7%

Question 48

What is the definition of large varices?

Answer 48

Greater than 5 mm in diameter

Question 49

What is the risk of bleeding from large varices by 2 years?

Answer 49

30%

Question 50

What are the morphologic features of varices observed at endoscopy?

Answer 50

* Red wale marks * Cherry red spots * Hematocystic spots * Diffuse erythema

Question 51

What are the primary prevention strategies for esophageal variceal bleeding?

Answer 51

* Beta-blockers (BB) * Band ligation

Question 52

What treatments are used to achieve hemostasis in patients with acute variceal hemorrhage?

Answer 52

* PPI (Proton Pump Inhibitors) * Somatostatin * Terlipressin

Question 53

What is spontaneous bacterial peritonitis (SBP)?

Answer 53

A bacterial infection of almost always cirrhotic ascitic fluid without any intra-abdominal surgically treatable source of infection

Question 54

What is the risk of sepsis in patients with cirrhosis compared to those without chronic liver disease (CLD)?

Answer 54

2.6-fold higher

Question 55

What is the most common type of infection in patients with cirrhosis?

Answer 55

Spontaneous bacterial peritonitis (SBP)

Question 56

What is the most common organism responsible for SBP infections?

Answer 56

Gram-negative bacteria (~60%)

Question 57

What are the clinical presentations of SBP?

Answer 57

* Asymptomatic * Local symptoms * Systemic symptoms * Deterioration of liver function * Hepatic encephalopathy * AKI * Septic shock

Question 58

What PMN count in ascitic fluid indicates a diagnosis of SBP?

Answer 58

≥250 cells/mm3

Question 59

What should be tested during a diagnostic paracentesis?

Answer 59

* Aerobic and anaerobic culture * Cell count and differential * Gram stain * Albumin * Protein * Glucose * LDH * Amylase * Bilirubin

Question 60

What is hepatic encephalopathy?

Answer 60

A serious, reversible metabolic syndrome characterized by neuropsychiatric dysfunction on the background of advanced liver disease

Question 61

What percentage of patients with cirrhosis develop hepatic encephalopathy?

Answer 61

50% to 70%

Question 62

What are the potential precipitating causes of hepatic encephalopathy?

Answer 62

* Medications * Toxins * Gastrointestinal bleeding * Hypovolemia

Question 63

What are the classifications of hepatic encephalopathy?

Answer 63

* Minimal hepatic encephalopathy (MHE) * Overt hepatic encephalopathy (OHE)

Question 64

What is the role of ammonia in the pathogenesis of hepatic encephalopathy?

Answer 64

Neurotoxin production and altered permeability of the blood-brain barrier

Question 65

What is the main method for diagnosing hepatic encephalopathy?

Answer 65

Clinical assessment

Question 66

What is the importance of providing appropriate nutritional support in hepatic encephalopathy management?

Answer 66

To avoid malnutrition and electrolyte abnormalities

Question 67

What is the recommended first-line treatment for agitation in hepatic encephalopathy?

Answer 67

Haloperidol