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Cirrhosis

Terms in this set (44)

There is no staging for cirrhosis
...
T/F: Cirrhosis is reversible
false
How does the patient look?
1. palmar erythema
2. ascites
3. muscle wasting
4. white streak in middle of nail
5. telangectasia on their chest (sometimes on their face)
Causes of cirrhosis
1. hepatitis
2. primary biliary cirrhosis
3. alcohol
4. fatty liver
--more
How many years does it take to develop cirrhosis?

A) 10-20
B) 20-30
C) 30-40
B) 20-30
a patient with cirrhosis may report
Fatigue
Pruritus
Abdominal pain
Menstrual abnormalities
anorexia
What are some other physical exam findings?
1. Spider angiomas
2. Fetor hepaticus- sweet smell to their breath
3. Jaundice
4. Asterixis
5.Hepatomegaly/splenomegaly
6. Palmar erythema
7. Gynecomastia
8. Bruising
What will you see on imaging?
1. nodular liver
2. coarsened echotexture
3. hepatomegaly/splenomegaly
4. portal HTN
T/F: Liver biopsy is needed for all cirrhosis patients
false- you can get the dx without it. But it can help you determine the underlying cause.

Get a biopsy if you suspect a viral cause or autoimmune cause
What things indicate decompensated liver disease
Esophageal Varices
Ascites
LE edema
Hepatic Encephalopathy
Jaundice
sonographic findings of portal HTN
Sonographic findings include development of collaterals, increased portal vein diameter, decreased flow velocity
If you have portal HTN the fluid will back up, causing...
findings of esophageal varices, ascites, LE edema
Treatment for ascites
1. paracentesis
2. low sodium diet
3. diuretics
4. TIPS
Anyone with cirrhosis must have a screening EGD
...
How often should you monitor a TIPS (shunt)

A) every 2 months
B) every 4 months
C) every 6 months
D) every year
C) monitor for patency with u/s doppler every 6 months or if patient develops ascites/LE edema
what is hepatic encephalopathy
*Brain dysfunction caused by liver insufficiency

*may be related to bacteria from the intestine getting into portal blood and/or ammonia
Common exam findings in patients with hepatic encephalopathy
Exam findings of asterixis and hepatic fetor, mostly subjective
First line of treatment for hepatic encephalopathy
lactulose
How does lactulose work
creates acidic environment in GI tract to decrease bacterial growth
What is a antibiotic used for hepatic encephalopathy
xifaxan (also called rifaxin?)
How does xifaxan work?
It is a non-systemic antibiotic. It targets gut bacteria.
MELD score stands for
Model for End stage Liver Disease
What does the MELD score calculate (predict)
predicts 3 month mortality for a patient
Scores for MELD range from __ to __
6 to 40

6 is normal. 15 is the cut off saying you need a liver transplant.
What are the 5 parameters of the Child-pugh score?
Serum bilirubin
Serum albumin
Prothrombin time
Ascites
Encephalopathy
screening for hepatocellular carcinoma is recommended every ___ months
every 6 months
screening for HCC involves 2 things
AFP and abdominal U/S
You should be suspicious of HepC in people who got blood transfusion prior to _______ (year)
1990
How long from virus exposure (hep C) to cirrhosis
20-30 years from initial infection to cirrhosis
What do you give a patient for treatment if they have autoimmune hepatitis
steroids in combo with immunomodulator
How do you diagnose autoimmune hepatitis?
liver biopsy
What labs can you use to diagnose primary biliary cirrhosis?
1. positive AMA
2. elevated serum alkaline phosphatase
what is the main symptoms of primary biliary cirrhosis?
pruritus
primary biliary cirrhosis and primary sclerosing cholangitis puts a patient at increased risk of
osteoporosis and vit D deficiency
Primary Sclerosing Cholangitis is seen mainly in

A) men in 50s
B) women in 50s
C) men in 60s
D) women in 60s
A) men in 50s
70-80% of those with primary sclerosing cholangitis have what autoimmune disease also?
ulcerative colitis
In people with alcoholic cirrhosis the ______ is 2x greater than ______

AST
ALT
AST usually 2 x greater than ALT
Hemochromatosis can lead to cirrhosis. What is hemochromatosis?
iron overload
What is wilson's disease
disorder of copper metabolism
What serum level will be low in Wilson's disease
ceruloplasmin
if ceruloplasmin level is low go ahead and get
a 24 hour urine copper level
treament for Wilson's disease
Treatment is copper-chelating drug Trientine and zinc supplementation
Most transplant programs require a BMI < ___
< 40
Liver transplant only done if MELD score > __

A) 8
B) 10
C) 12
D) 15
15
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