Cirrhosis: Etiology, Features, and Complications

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Questions and Answers

Which of the following best describes the pathophysiology linking portal hypertension to the development of ascites?

Reduced hepatic synthesis of albumin leads to decreased oncotic pressure, promoting fluid extravasation into the peritoneal space, exacerbated by increased portal venous pressure. (correct)
Portal hypertension causes increased lymphatic drainage from the liver, overwhelming the lymphatic system's capacity to return fluid to the systemic circulation.
Increased portal pressure directly forces fluid into the peritoneal cavity due to disruption of the liver capsule.
Elevated portal venous pressure stimulates the kidneys to retain sodium and water, leading to increased intravascular volume and subsequent ascites formation.

A patient with cirrhosis and known oesophageal varices is admitted with haematemesis. After initial resuscitation, which intervention has the highest priority in the acute management?

Urgent abdominal paracentesis to relieve potential ascites-related pressure on varices.
Administration of intravenous Vitamin K to correct coagulopathy.
Endoscopic variceal ligation to directly control the source of bleeding. (correct)
Commencement of a high-protein diet to promote liver regeneration.

In a patient with portal hypertension secondary to cirrhosis, which laboratory finding would be LEAST expected?

Elevated alanine transaminase (ALT) and aspartate transaminase (AST).
Elevated serum albumin. (correct)
Prolonged prothrombin time.
Reduced platelet count.

A patient with portal hypertension and cirrhosis develops hepatic encephalopathy. What is the primary mechanism by which lactulose improves this condition?

Lactulose acidifies the colon, converting ammonia ($NH_3$) to ammonium ($NH_4^+$), which is then excreted in the faeces, reducing ammonia absorption. (A) Signup and view all the answers

Which statement best explains the rationale for restricting dietary sodium in a patient with portal hypertension and ascites?

Decreased sodium intake reduces intravascular volume by decreasing water retention, which subsequently minimizes fluid extravasation into the peritoneal cavity. (C) Signup and view all the answers

A cirrhotic patient with portal hypertension develops spontaneous bacterial peritonitis (SBP). Besides antibiotics, which of the following is MOST likely to improve survival in this patient population?

Administration of intravenous albumin. (C) Signup and view all the answers

Which of the following mechanisms most directly contributes to the formation of ascites in patients with liver cirrhosis?

Visceral venodilation causing pooling of blood in the abdominal cavity, compounded by reduced serum albumin leading to decreased blood osmotic pressure. (B) Signup and view all the answers

A patient with cirrhosis develops hepatic encephalopathy. What is the underlying mechanism for this condition?

The liver's impaired ability to detoxify nitrogenous waste products, leading to elevated ammonia levels that affect brain function. (A) Signup and view all the answers

What is the most likely reason for a patient with cirrhosis and portal hypertension to develop thrombocytopenia?

Sequestration of platelets in the enlarged spleen (hypersplenism) secondary to portal hypertension. (B) Signup and view all the answers

A patient with known cirrhosis and portal hypertension presents with sudden altered mental status. After ruling out other causes, hepatic encephalopathy is suspected. Which medication would be LEAST appropriate to manage this patient's acute condition?

Furosemide. (D) Signup and view all the answers

Hepatorenal syndrome (HRS) is a severe complication of cirrhosis. Which pathophysiological process is most directly implicated in the development of HRS?

Venodilation in the portal circulation leading to blood pooling, distributive shock, and subsequent renal hypoperfusion. (D) Signup and view all the answers

In a patient with cirrhosis, what is the most significant consequence of impaired prothrombin synthesis by the liver?

Increased risk of bleeding due to impaired blood coagulation. (B) Signup and view all the answers

Why does portal vein obstruction lead to the formation of collateral venous channels in patients with portal hypertension?

To bypass the obstructed portal vein, allowing blood from the digestive tract and spleen to return to the systemic circulation. (B) Signup and view all the answers

What is the primary reason behind the development of spider naevi in individuals with liver cirrhosis?

Hormonal imbalances due to impaired liver metabolism, leading to increased estrogen levels and dilation of cutaneous arterioles. (B) Signup and view all the answers

Which of the following best explains why patients with cirrhosis are at an increased risk of developing hepatocellular carcinoma?

Chronic liver inflammation and regeneration, increasing the likelihood of mutations and uncontrolled cell growth. (B) Signup and view all the answers

Why is the formation of oesophageal varices a significant concern in patients with portal hypertension?

They can rupture and cause life-threatening gastrointestinal bleeding. (C) Signup and view all the answers

Flashcards

Portal Hypertension

Obstruction of the portal vein leading to increased pressure.

Main Cause of Portal Hypertension

Cirrhosis is the most common.