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Questions and Answers
What is a common clinical feature of cirrhosis related to endocrine changes in men?
What is a common clinical feature of cirrhosis related to endocrine changes in men?
Which imaging finding is typical in patients with cirrhosis?
Which imaging finding is typical in patients with cirrhosis?
Which condition is directly associated with portal hypertension?
Which condition is directly associated with portal hypertension?
What does the presence of spider telangiectasia indicate in a patient with liver disease?
What does the presence of spider telangiectasia indicate in a patient with liver disease?
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Which blood test result is typically elevated in liver damage associated with cirrhosis?
Which blood test result is typically elevated in liver damage associated with cirrhosis?
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What is the estimated prevalence of malnutrition in patients with decompensated cirrhosis?
What is the estimated prevalence of malnutrition in patients with decompensated cirrhosis?
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Which of the following is a potential complication of cirrhosis related to hepatic encephalopathy?
Which of the following is a potential complication of cirrhosis related to hepatic encephalopathy?
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Which of these conditions is most likely to result in cirrhosis due to prolonged biliary injury?
Which of these conditions is most likely to result in cirrhosis due to prolonged biliary injury?
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What is the first-line pharmacological treatment for managing ascites in patients requiring diuretics?
What is the first-line pharmacological treatment for managing ascites in patients requiring diuretics?
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What is the primary method of managing refractory ascites?
What is the primary method of managing refractory ascites?
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Which of the following is a potential complication following transjugular intrahepatic portosystemic stent shunt (TIPSS) placement?
Which of the following is a potential complication following transjugular intrahepatic portosystemic stent shunt (TIPSS) placement?
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What is the significance of an ascitic neutrophil count exceeding 250 × 106/L in diagnosis?
What is the significance of an ascitic neutrophil count exceeding 250 × 106/L in diagnosis?
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What is a common treatment regimen for hepatic encephalopathy?
What is a common treatment regimen for hepatic encephalopathy?
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Which of these clinical features is NOT associated with spontaneous bacterial peritonitis (SBP)?
Which of these clinical features is NOT associated with spontaneous bacterial peritonitis (SBP)?
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What is the recommended fluid intake restriction for patients with a plasma sodium level below 125 mmol/L?
What is the recommended fluid intake restriction for patients with a plasma sodium level below 125 mmol/L?
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Which of the following is the most common organism isolated in patients with spontaneous bacterial peritonitis?
Which of the following is the most common organism isolated in patients with spontaneous bacterial peritonitis?
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What is the primary purpose of using broad-spectrum antibiotics in patients with SBP?
What is the primary purpose of using broad-spectrum antibiotics in patients with SBP?
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Which of the following findings on ascitic culture would indicate a possible perforated viscus?
Which of the following findings on ascitic culture would indicate a possible perforated viscus?
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What is the diagnostic criterion for acute kidney injury in HRS-AKI?
What is the diagnostic criterion for acute kidney injury in HRS-AKI?
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Which type of HRS is characterized by a rapid reduction in renal function following an acute event?
Which type of HRS is characterized by a rapid reduction in renal function following an acute event?
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What is a common preventative measure for reducing SBP incidence in at-risk patients?
What is a common preventative measure for reducing SBP incidence in at-risk patients?
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Which of the following is NOT a criterion for diagnosing HRS-AKI?
Which of the following is NOT a criterion for diagnosing HRS-AKI?
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What does the management of HRS primarily involve?
What does the management of HRS primarily involve?
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Why are intravenous albumin doses recommended on specific days in patients with jaundice or renal impairment?
Why are intravenous albumin doses recommended on specific days in patients with jaundice or renal impairment?
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What is the median survival rate for patients with decompensated cirrhosis?
What is the median survival rate for patients with decompensated cirrhosis?
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Which combination of factors is considered a bad prognostic feature in cirrhosis?
Which combination of factors is considered a bad prognostic feature in cirrhosis?
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What is the recommended daily protein intake for patients with sarcopenia?
What is the recommended daily protein intake for patients with sarcopenia?
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What is one of the primary screenings used to detect esophageal varices?
What is one of the primary screenings used to detect esophageal varices?
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What SAAG gradient value suggests that ascites is likely due to portal hypertension?
What SAAG gradient value suggests that ascites is likely due to portal hypertension?
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Which of the following management strategies is essential for achieving negative sodium balance in ascites?
Which of the following management strategies is essential for achieving negative sodium balance in ascites?
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What is considered a complication of cirrhosis that can lead to complications like spontaneous bacterial peritonitis?
What is considered a complication of cirrhosis that can lead to complications like spontaneous bacterial peritonitis?
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Which of these features is NOT typically associated with ascites in patients with portal hypertension?
Which of these features is NOT typically associated with ascites in patients with portal hypertension?
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What is the most common primary liver tumor?
What is the most common primary liver tumor?
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Which condition is a major risk factor for hepatocellular carcinoma?
Which condition is a major risk factor for hepatocellular carcinoma?
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What serum marker is produced by 60% of HCCs and is indicative of disease progression?
What serum marker is produced by 60% of HCCs and is indicative of disease progression?
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What is the likelihood of developing hepatocellular carcinoma in the presence of cirrhosis?
What is the likelihood of developing hepatocellular carcinoma in the presence of cirrhosis?
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Which imaging technique is most reliable for confirming the diagnosis of hepatocellular carcinoma?
Which imaging technique is most reliable for confirming the diagnosis of hepatocellular carcinoma?
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What patient symptoms may indicate a deterioration of cirrhosis associated with hepatocellular carcinoma?
What patient symptoms may indicate a deterioration of cirrhosis associated with hepatocellular carcinoma?
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What is the treatment approach for hepatocellular carcinoma primarily based upon?
What is the treatment approach for hepatocellular carcinoma primarily based upon?
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What is the typical macroscopic appearance of HCC in the absence of cirrhosis?
What is the typical macroscopic appearance of HCC in the absence of cirrhosis?
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Study Notes
Liver Cirrhosis/Complications
- Cirrhosis is the liver's abnormal response to chronic injury, featuring diffuse hepatic fibrosis (scarring) and nodule formation.
- Any persistent or recurring hepatocyte injury can cause cirrhosis.
- Common causes include chronic viral hepatitis (B or C), excessive alcohol consumption, non-alcoholic fatty liver disease (NAFLD), prolonged biliary injury (like in primary biliary cholangitis (PBC), primary sclerosing cholangitis (PSC), and post-surgical biliary strictures).
- Persistent venous return impairment within the liver (e.g., sinusoidal obstruction syndrome (SOS/VOD), Budd-Chiari syndrome, cardiac hepatopathy) can also lead to cirrhosis.
- Genetic factors like hemochromatosis, Wilson's disease, and α1-antitrypsin deficiency contribute to cirrhosis.
Causes of Cirrhosis
- Alcohol consumption
- Chronic Viral Hepatitis (types B or C)
- Non-alcoholic fatty liver disease (NAFLD)
- Immune Mediated: Primary sclerosing cholangitis, Autoimmune liver disease
- Biliary: Primary biliary cholangitis, Secondary biliary cirrhosis, Cystic fibrosis
Clinical Features of Cirrhosis
- General: Weakness, fatigue, muscle cramps, weight loss, anorexia, nausea, upper abdominal discomfort
- Jaundice
- Hepatomegaly or hepatosplenomegaly (enlarged liver or liver and spleen)
- Circulatory changes: Spider telangiectasia, palmar erythema
- Endocrine changes: Loss of libido, hair loss, gynecomastia (men), breast atrophy, irregular menses (women)
- Hemorrhagic tendency: Bruises, purpura, epistaxis
- Portal hypertension: Splenomegaly, collateral vessels, variceal bleeding
- Hepatic encephalopathy
- Other features: Pigmentation (hemochromatosis), Dupuytren's contracture
Investigations for Cirrhosis
- Complete Blood Count (CBC): Low hemoglobin, low platelet count
- Kidney function tests: Normal or high urea/creatinine
- Liver function tests: Prolonged prothrombin time (PT), low albumin, elevated bilirubin
- Liver damage tests: Elevated AST, ALT, alkaline phosphatase
- Liver ultrasound: Coarse echotexture, nodularity, decreased liver size
- Surveillance tests: Alpha-fetoprotein (AFP), sonography, endoscopy, paracentesis
Management of Cirrhosis
- Treat underlying cause
- Maintain nutrition: Daily calorie intake (35 kcal/kg body weight), protein intake (1.2-1.5 g/kg)
- Treat complications
Prognosis of Cirrhosis
- Compensated Cirrhosis: Good prognosis, median survival >12 years
-
Decompensated Cirrhosis: Poor prognosis, median survival about 2 years
- Indicators of poor prognosis include elevated bilirubin, low albumin, prolonged prothrombin time (PT), renal dysfunction, and hyponatremia.
Complications of Cirrhosis
- Ascites: Accumulation of fluid in the abdominal cavity
- Spontaneous bacterial peritonitis (SBP): Bacterial infection in the ascitic fluid
- Variceal hemorrhage
- Hepatic encephalopathy
- Hepatocellular carcinoma (HCC)
- Hepatorenal syndrome (HRS): Renal dysfunction in advanced liver disease due to reduced renal blood flow.
Screening for Complications
- Endoscopy: Screening for esophageal varices
- US abdomen and alpha-fetoprotein (AFP): Screening for hepatocellular carcinoma (HCC)
- Bone mineral density: Screening for osteoporosis
Management of Complications
- Ascites: Sodium restriction, diuretics (spironolactone, furosemide), large-volume paracentesis, TIPS (Transjugular intrahepatic portosystemic shunt)
- SBP: Broad-spectrum intravenous antibiotics
- Hepatic encephalopathy: Lactulose, rifaximin
- HCC: Surgery, ablation, chemotherapy/systemic therapy; depending on tumor size/numerosity and overall liver functioning
Hepatocellular Carcinoma (HCC)
- Most common primary liver tumor.
- Frequently associated with cirrhosis.
- Risk factors include chronic hepatitis B, hemochromatosis, alcohol use, and non-alcoholic fatty liver disease (NAFLD).
- Macroscopically, often appears as a single mass in the absence of cirrhosis or multiple nodules in the presence.
- Diagnostic imaging and serum alpha-fetoprotein (AFP) levels are crucial for diagnosis and monitoring.
Hepatorenal Syndrome (HRS)
- Renal dysfunction in advanced liver disease.
- Reduced renal perfusion, splanchnic vasodilation, and overactivity of endogenous vasoactive systems.
- Two types: HRS-AKI (acute kidney injury) and HRS-NAKI (non-acute kidney injury).
Pleural Effusion/Hepatic Hydrothorax
- Movement of ascitic fluid into the pleural space.
- Usually right-sided.
- Diagnosis with a pleural fluid analysis to observe albumin gradient.
- Treatment: Diuretic therapy, periodic thoracentesis, TIPS, liver transplantation.
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Description
Test your knowledge on cirrhosis and its multifaceted clinical features, including endocrine changes, imaging findings, and complications. This quiz covers aspects like portal hypertension, ascites management, and malnutrition prevalence in patients with decompensated cirrhosis.
