Term
What are the pathological archeture types of cirrhosis?
What does each suggest about the cause |
|
Definition
Microlobular: Alcohol
Macrolobular: Viral |
|
|
Term
| What does decompensated cirrhosis indicate |
|
Definition
| One of more complications of cirrhosis are present |
|
|
Term
| What are the major causes of cirrhosis? |
|
Definition
Fatty Liver: Alcohol, NASH
Viral: B, C, D
Autoimmune: Autoimune Hepititis, PBS, PSC
Genetic: Wilson's Hereditary hemochromatosis, Alpha1-Antitrypsin deficiency
Also: Drugs, CHF/Venous |
|
|
Term
| Physical Exam Findings of Cirrhosis |
|
Definition
Jaudice
Leukonychia
Palmar Erythema
Spider Angioma
Gynecomastia/Testicular Atrophy
Caput Medusa
Ascites
Splenomegaly |
|
|
Term
| Abnormal lab values in cirrhosis? |
|
Definition
INR
High Bilirubin
Thrombocytopenia-> Pancytopenia
Albumin
AST, ALT |
|
|
Term
| What is the appearance of cirrhosis and portal hypertension on CT or MRI? |
|
Definition
Small Shunken Liver
Enlarged Caudate lobe
Enlarged Portal Vein
Recanalized Parumbilical veins
Visceral Varices
Splenomegaly
Ascites
|
|
|
Term
What is the gold standard for diagnosing liver cirrhosis?
How is the diagnosis typically made? |
|
Definition
Liver Biopsy
Typically made by appearance of complications
or Radiographic diagnosis |
|
|
Term
What are the mechanisms of portal HPTN from cirrhosis?
At what pressures do to complications become appearent? |
|
Definition
Ito cells fibrose sinusoid increasing resistance
Splanchnic arterioles dialate increasing flow
Pressure: >12 mmHg |
|
|
Term
| What is the most common complication of cirrhosis and which is the most deadly? |
|
Definition
Common: Ascites
Worst: Hepatorenal Syndrome |
|
|
Term
What are the risk factors that are predictive of variceal bleeding?
What vein is the cause of esophogeal varices from cirrhosis? |
|
Definition
Risks
Size
Red Signs
Child's Score
Esophogeal: Coronary Vein |
|
|
Term
What is used prophyllatically to prevent variceal bleeding?
How do you treat an acute bleed?
How is refractory variceal Bleeding Treated? |
|
Definition
Prevent Bleeding: NS Beta-blockers
Acute:
Transfusion
Octreotide/Somatostatin
Bandligation/Sclerotherapy
Refractory: TIPS-Transjugular Intrahepatic Portosystemic Shunt |
|
|
Term
What is the pathogenesis of Ascites formation from cirrhosis?
How do you analyze the cause of ascites
How do you treat ascites?
|
|
Definition
Pathophys:
Increased hydrostatic
Decreased oncotic(albumin)
Enteric vasodialation
Sodium reabsorption from decreased effective volume
SAAG(Serum Albumin-Ascites Albumin)
High SAAG (>1.1 g/dL): Portal HPTN
Low SAAG: Bacterial/Malignancy
TX
Sodium Restriction
Diuretics
Refractory:TIPS |
|
|
Term
What is Spontaneous Bacterial Peritonitis?
What is the pathogenesis?
What is the treatment |
|
Definition
Single organism and >250 PNMs/microL
Pathogen: Decreased RES kupfer activity bc most fluid bypasses liver
Tx: Acute and longterm Antibiotics |
|
|
Term
Cause of Hepatorenal syndrome?
What are the types?
Prognosis? |
|
Definition
Vasoconstriction from peripheral vasodilation
Type 1(Creatinine doubles in 2 weeks): 14 days
Type 2: 6 months |
|
|
Term
What is the probable cause of Hepatic Encephalopathy?
How is it diagnosed?
How is it commonly treated? |
|
Definition
Decreased ammonia excretion causing neurosteroid production
Dx: Asterixis(flapping tremor)
Tx: Lactulose
|
|
|
Term
| What is the screening regimen for hepatocellular carcinoma in a patient with cirrhosis? |
|
Definition
| AFP and Ultrasound every 6 months |
|
|
Term
| What are the prognostic methods for liver transplant? |
|
Definition
Child-Turcotte-Pugh(each rated 1-3)
Bilirubin,
INR
Albumin
Encephalopathy
Ascites
Model for End-Stage Liver Disease(MELD)
Billirubin
INR
Creatinine |
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