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From Flashcardlet > Med Cirrhosis > Flashcards

Med Cirrhosis Flashcards

0
Q

> 3mm

Nodular variation

A

Macronodular cirrhosis

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1
Q

< 3mm

Uniform nodule

A

Micronodular cirrhosis

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2
Q

Diagnosis of cirrhosis

A

Liver biopsy

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3
Q

Most common complication of liver cirrhosis

A

Hepatocellular carcinoma

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4
Q

Portal HPN classification of Hepatic vein thrombosis

A

Post hepatic

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5
Q

Portal HPN classification of Constrictive pericarditis

A

Post hepatic

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6
Q

Portal HPN classification of veno occlusive disease

A

Intrahepatic

Post sinusoidal

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7
Q

Portal HPN classification of schistosomiasis

A

Intrahepatic presinusoidal

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8
Q

Portal HPN classification of alcoholic cirrhosis

A

Sinusoidal

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9
Q

Portal HPN classification of portal or splenic vein thrombosis

A

Prehepatic

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10
Q

Mortality rate for each bleeding episode?

A

30-50%

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11
Q

Risk of recurrent variceal hemorrhage

A

50-70%

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12
Q

recurrent variceal hemorrhage occur within

A

2 years

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13
Q

4 risk factors for variceal bleeding

A

Large esophageal varices
Endoscopy: red wale marking or cherry red sign
Child’s Pugh criteria C (10-15pts)
Hepatic venous pressure gradient of > 12mmHg

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14
Q

Pharmacologic treatment for variceal bleeding

A

Vasoconstrictors:
Somatostatin/octreotide
Vasopressin
Nitroglycerine

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15
Q

5 preventive strategies for recurrent variceal bleeding

A 
Endoscopic ligation or sclerotherapy
Beta blockers or propranolol
TIPS
Surgical shunts
Liver transplantation
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16
Q

Points for grades ABC of Child’s Pugh Criteria

A 
A= 5-6 points
B= 7-9 points
C= 10-15 points
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17
Q

Prevention of first bleed from patients who have never bled

A

Propranolol

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18
Q

Definitive treatment of actively bleeding varices

A

Variceal ligation or sclerotherapy

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19
Q

If bleeding recurs after variceal ligation

A

TIPS

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20
Q

If bleeding continues after variceal sclerotherapy

A 
Balloon tamponade
(If hepatic function is poor, LIVER TRANSPLANTATION)
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21
Q

Fluid in peritoneal cavity

A

Ascites

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22
Q

Most common cause of ascites

A

Chronic liver disease (cirrhosis)

23
Q

3 factors producing ascites in cirrhosis

A

Portal HPN
Hypoalbuminemia
Overproduction of lymph

24
Q

Critical imbalance in starling forces

A

Underfill theory

25
Q

Na+ retention leading to increased blood volume

A

Overflow theory

26
Q

Combination of underfill and overflow theory

A

Peripheral arteriolar vasodilation

27
Q

Indications for diagnostic paracentesis

Drain 4L max to prevent hypovolemia and shock

A

New onset ascites
Hospital admission
Clinical deterioration
Fever

No Contraindication

28
Q

Fluid analysis tests for ascites (6)

A 
Cell count
Culture
Cytology
Total protein/albumin
Gram stain
TB smear and culture
29
Q 
High or low serum-ascites albumin gradient?
Cirrhosis
Alcoholic hepatitis
Liver metastasis
Portal vein thrombosis
Cardiac disease
A

High (> 1.1 g/dl)

30
Q 
High or low serum-ascites albumin gradient?
Peritoneal carcinomatosis
TB peritonitis
Biliary leak
Nephrotic syndrome
Serositis
A

Low < 1.1g/dL

31
Q

Treatment for ascites

A

Na+ restriction (low salt diet)
Fluid restriction (1-1.5 L/day)
Stepwise increase in diuretics (prevent dehydration and hepatic encephalopathy)
Large volume paracentesis (for tense ascites that causes respi compli)

32
Q

Refractory ascites causes

A

SBP
Tense ascites
Umbilical hernia
Hydrothorax

33
Q

High or low in ascites?

Bilirubin and protime

A

High

34
Q

SSx of SBP

A 
(similar to reynold's pentad)
(FPJ CHaT)
Fever
Abd pain
Jaundice
Confusion
Hypotension
Abd Tenderness
35
Q

Anaerobe bacteria in SBP

A

E. Coli (most common)
Klebsiella
Streptococcus
Enterobacteriaceae

36
Q

Indication for broad spectrum antibiotic in SBP

A

PMN > or = 250/mm3

37
Q

Broad spectrum antibiotics for SBP

A

Co-amoxiclav
Quinolones
Cephalosporins

(5days)

AVOID AMINOGLYCOSIDES

38
Q

A complication of cirrhosis that is a diagnosis by exclusion

A

Hepatorenal syndrome

39
Q 
Presents with:
Progressive ascites
Hypotension
Oliguria
Jaundice
A

Hepatorenal syndrome

40
Q

Labs of hepatorenal syndrome

A 
Azotemia
Hyponatremia
Urine Na+: <10 meq/L
Urine sediments: unremarkable
Urine plasma-creatinine ratio: >30
Urine plasma osmolality ratio: >1
41
Q

Reversible neuropsychiatric abnormalities
(With asterixis and abnormal EEG)
Due to high ammonia levels

A

Hepatic enchephalopathy

42
Q

Substances that contribute or cause hepatic encephalopathy

A

NH3
Tryptophan
GABA
Benzodiazepine

43
Q

Psychomotor test

Psych test for asterixis

A

Bender-Gestalt tests

44
Q

3 spectra of hepatic encephalopathy

A

Subclinical
Recurrent
Chronic

45
Q

(4 stages of hepatic coma)

Drowsiness

A

Stage 2

46
Q

(4 stages of hepatic coma)

Somnolence

A

Stage 3

47
Q

(4 stages of hepatic coma)

Impaired handwriting

A

Stage 1

48
Q

(4 stages of hepatic coma)

Tremors

A

Stage 1

49
Q

(4 stages of hepatic coma)

Asterixis

A

Stage 2

50
Q

(4 stages of hepatic coma)

Inverse sleep pattern

A

Stage1

51
Q

(4 stages of hepatic coma)

+ EEG changes

A

Stage 3

52
Q

(4 stages of hepatic coma)

Personality changes

A

Stage 2

53
Q

(4 stages of hepatic coma)
Hyperreflexia
+ babinski sign

A

Stage 3

54
Q

(4 stages of hepatic coma)

Muscle rigidity

A

(4 stages of hepatic coma)

55
Q

Discoordinated movement

A

Ataxia

56
Q

Management of hepatic encephalopathy

A

Neomycin
Metronidazole
Laxatives

Maybe: sulbactam or ampicillin

From Flashcardlet (33 decks)

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