Cirrhosis Overview Quiz
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Questions and Answers

What is the main characteristic of cirrhosis?

  • Extensive degeneration of liver cells and scarring of the liver tissue.
  • Extensive degeneration of liver cells and replacement of liver tissue with scar tissue and regenerative nodules. (correct)
  • Extensive degeneration and destruction of liver cells.
  • Degeneration of the liver cells followed by fibrosis.

    • What are the most common causes of cirrhosis in the United States?

  • Chronic HCV infection, NASH, and alcohol-induced liver disease. (correct)
  • Extreme dieting, malabsorption, and obesity.
  • Viral hepatitis, alcohol use, and biliary causes.
  • Long-standing, severe, right-sided heart failure.

    • Which of the following is NOT a common cause of cirrhosis?

  • Chronic bacterial infection. (correct)
  • Chronic hepatitis.
  • Alcohol use.
  • PBC and PSC.

    • How does alcohol use contribute to the development of cirrhosis?

    <p>All of the above. (D)</p> Signup and view all the answers

    What is the effect of the regenerative process in cirrhosis?

    <p>It results in abnormal blood vessel and bile duct architecture. (C)</p> Signup and view all the answers

    Which of the following is a late manifestation of cirrhosis?

    <p>Portal hypertension. (D)</p> Signup and view all the answers

    How does impaired blood flow contribute to the development of cirrhosis?

    <p>All of the above. (D)</p> Signup and view all the answers

    What is the role of fibrosis in the development of cirrhosis?

    <p>It blocks blood flow and hampers liver function. (D)</p> Signup and view all the answers

    Which of the following symptoms is NOT a common late manifestation of cirrhosis?

    <p>Hypertension (A)</p> Signup and view all the answers

    What is the primary reason for jaundice in individuals with cirrhosis?

    <p>Decreased ability to conjugate and excrete bilirubin (C)</p> Signup and view all the answers

    What is the primary cause of splenomegaly in cirrhosis?

    <p>Backup of blood from the portal vein (D)</p> Signup and view all the answers

    What is the common cause of anemia in individuals with cirrhosis?

    <p>All of the above (D)</p> Signup and view all the answers

    Which of the following is NOT a potential cause of coagulation problems in cirrhosis?

    <p>Increased blood viscosity (C)</p> Signup and view all the answers

    What is the primary cause of gynecomastia in men with cirrhosis?

    <p>Increased estrogen production (B)</p> Signup and view all the answers

    Which of the following is a hallmark of portal hypertension?

    <p>Enlarged collateral veins (B)</p> Signup and view all the answers

    What is the most life-threatening complication of cirrhosis?

    <p>Ruptured esophageal varices (C)</p> Signup and view all the answers

    Why is peripheral edema a common finding in individuals with cirrhosis?

    <p>Decreased protein levels in the blood (B)</p> Signup and view all the answers

    What is the difference between compensated and decompensated cirrhosis?

    <p>Compensated cirrhosis has no complications, while decompensated cirrhosis does (C)</p> Signup and view all the answers

    Which of the following is a common complication of portal hypertension?

    <p>All of the above (D)</p> Signup and view all the answers

    What is the mechanism of ascites development in cirrhosis?

    <p>All of the above (D)</p> Signup and view all the answers

    What is the primary cause of peripheral neuropathy in alcoholic cirrhosis?

    <p>Dietary deficiencies (C)</p> Signup and view all the answers

    Which of the following is a characteristic of hepatic encephalopathy?

    <p>Confusion, lethargy, and sleepiness (A)</p> Signup and view all the answers

    What is the primary cause of hepatic coma?

    <p>Liver failure (A)</p> Signup and view all the answers

    Which of the following is NOT a common laboratory finding in cirrhosis?

    <p>Increased albumin (A)</p> Signup and view all the answers

    Which of the following is NOT a mechanism of ascites formation?

    <p>Increased renal blood flow leading to increased glomerular filtration (C)</p> Signup and view all the answers

    What is the primary cause of hypokalemia in patients with ascites?

    <p>Increased potassium excretion due to hyperaldosteronism (A)</p> Signup and view all the answers

    Which of the following is NOT a manifestation of ascites?

    <p>Weight loss (C)</p> Signup and view all the answers

    Which of the following is a common complication of hospitalized patients with cirrhosis and ascites?

    <p>Spontaneous bacterial peritonitis (B)</p> Signup and view all the answers

    Which of the following is NOT a contributing factor to the development of hepatic encephalopathy?

    <p>Increased production of antidiuretic hormone (A)</p> Signup and view all the answers

    What is the most common source of ammonia in individuals with hepatic encephalopathy?

    <p>Bacterial and enzymatic deamination of amino acids in the intestines (A)</p> Signup and view all the answers

    What is the primary function of a transjugular intrahepatic portosystemic shunt (TIPS) in the context of hepatic encephalopathy?

    <p>To reduce portal hypertension by diverting blood flow around the liver (B)</p> Signup and view all the answers

    Which of the following is a characteristic manifestation of hepatic encephalopathy?

    <p>Asterixis (flapping tremors) (A)</p> Signup and view all the answers

    What is the primary characteristic of hepatorenal syndrome?

    <p>Renal failure with no structural problems in the kidneys (C)</p> Signup and view all the answers

    Which of the following is NOT a risk factor for developing hepatorenal syndrome?

    <p>Increased physical activity (C)</p> Signup and view all the answers

    Which of the following liver function tests is typically elevated in the early stages of cirrhosis?

    <p>Alkaline phosphatase (C)</p> Signup and view all the answers

    Which of the following liver function tests is typically decreased in the end-stage liver disease?

    <p>Serum total protein (D)</p> Signup and view all the answers

    What is the purpose of a liver biopsy in the diagnosis of cirrhosis?

    <p>To assess the extent of liver cell damage and fibrosis (B)</p> Signup and view all the answers

    Which of the following is NOT a potential consequence of severe ascites?

    <p>Increased risk of pulmonary embolism (C)</p> Signup and view all the answers

    Which of the following is NOT a common finding in patients with severe ascites?

    <p>Increased urine output (C)</p> Signup and view all the answers

    What is the primary mechanism by which ammonia contributes to the development of hepatic encephalopathy?

    <p>Interfering with neurotransmitter function (C)</p> Signup and view all the answers

    Which of the following is NOT a potential complication of cirrhosis?

    <p>Kidney stones (C)</p> Signup and view all the answers

    Which of the following is a non-invasive test used to quantify the degree of liver fibrosis?

    <p>Ultrasound elastography (C)</p> Signup and view all the answers

    Sodium restriction is a key component of managing which complication of cirrhosis?

    <p>Ascites (B)</p> Signup and view all the answers

    Which diuretic is often used in combination with a potassium-sparing drug for ascites management?

    <p>Furosemide (D)</p> Signup and view all the answers

    What is the primary goal of treating esophageal and gastric varices?

    <p>Both A and B (A)</p> Signup and view all the answers

    Which of the following medications is NOT typically used to treat bleeding varices?

    <p>Acetaminophen (B)</p> Signup and view all the answers

    What is the primary mechanism of action of octreotide and vasopressin in managing bleeding varices?

    <p>Reduce portal blood flow (B)</p> Signup and view all the answers

    Which of the following procedures is used to place a small rubber band around the base of a varix?

    <p>Endoscopic variceal ligation (A)</p> Signup and view all the answers

    Which of the following is NOT a supportive measure during acute variceal bleeding?

    <p>Antibiotics (C)</p> Signup and view all the answers

    Which of the following procedures creates a shunt to redirect portal blood flow, thus reducing portal venous pressure and decompressing varices?

    <p>TIPS (C)</p> Signup and view all the answers

    What is the primary goal of managing hepatic encephalopathy?

    <p>Reduce ammonia formation in the intestines (C)</p> Signup and view all the answers

    What is the primary mechanism of Lactulose and Rifaximin in managing hepatic encephalopathy?

    <p>Decrease ammonia production in the gut (A)</p> Signup and view all the answers

    Which of the following is NOT a contraindication for TIPS?

    <p>Mild to moderate hepatic encephalopathy (A)</p> Signup and view all the answers

    Which of the following is a surgical procedure used to treat recurrent variceal bleeding?

    <p>TIPS (C)</p> Signup and view all the answers

    Which drug is a resin that binds bile salts in the intestine?

    <p>Cholestyramine (A)</p> Signup and view all the answers

    What is the main goal of conservative therapy for cirrhosis?

    <p>Both B and C (C)</p> Signup and view all the answers

    What is the recommended diet for a patient with cirrhosis without complications?

    <p>High in calories, high in carbohydrates, and moderate to low in fats (D)</p> Signup and view all the answers

    Which of the following is NOT recommended for patients with cirrhosis?

    <p>Acetaminophen (B)</p> Signup and view all the answers

    What are the common risk factors for cirrhosis?

    <p>Excessive alcohol consumption, malnutrition, viral hepatitis, and biliary obstruction (A)</p> Signup and view all the answers

    Which of the following is a potassium-sparing diuretic used to treat ascites in patients with cirrhosis?

    <p>Spironolactone (C)</p> Signup and view all the answers

    What is the role of lactulose in the management of hepatic encephalopathy?

    <p>To decrease ammonia production in the intestines (A)</p> Signup and view all the answers

    Which of the following procedures involves withdrawing fluid from the abdominal cavity to relieve pressure and discomfort?

    <p>Paracentesis (A)</p> Signup and view all the answers

    Which of the following is a common problem in patients with cirrhosis on diuretics?

    <p>Hyponatremia (B)</p> Signup and view all the answers

    Which of the following is a potential complication of TIPS?

    <p>Increased risk for hepatic encephalopathy (C)</p> Signup and view all the answers

    What type of nutritional therapy is given for severe malnutrition in patients with cirrhosis?

    <p>Parenteral nutrition (PN) or enteral nutrition (EN) (C)</p> Signup and view all the answers

    What is the goal of health promotion in patients with cirrhosis?

    <p>To prevent or delay the progression of cirrhosis (D)</p> Signup and view all the answers

    What is the main focus of acute care for patients with cirrhosis?

    <p>To manage complications of cirrhosis (A)</p> Signup and view all the answers

    Which of the following is a measure to relieve itching associated with jaundice in a patient with cirrhosis?

    <p>Using cholestyramine or hydroxyzine (D)</p> Signup and view all the answers

    Which of the following is NOT a commonly used surgical shunt for decreasing portal hypertension?

    <p>Transjugular intrahepatic portosystemic shunt (TIPS) (D)</p> Signup and view all the answers

    In the management of hepatic encephalopathy, which of the following is essential to minimize ammonia buildup?

    <p>Maintaining regular bowel movements (C)</p> Signup and view all the answers

    Which of the following is a drug that may be given to patients with hepatic encephalopathy who do not respond to lactulose?

    <p>Rifaximin (B)</p> Signup and view all the answers

    What measure can help relieve itching associated with cirrhosis?

    <p>Taking a warm bath with baking soda (B)</p> Signup and view all the answers

    What is a potential complication of using a balloon tamponade to control bleeding varices?

    <p>Risk of esophageal rupture (B)</p> Signup and view all the answers

    What is a common sign of fluid overload in a patient with cirrhosis?

    <p>Edema in the lower extremities (C)</p> Signup and view all the answers

    What is a nursing intervention for a patient with cirrhosis who is experiencing dyspnea?

    <p>All of the above (D)</p> Signup and view all the answers

    What nursing intervention is crucial to prevent skin breakdown in a patient with edema due to cirrhosis?

    <p>Using an alternating-air pressure mattress (C)</p> Signup and view all the answers

    Which of these is NOT a potential sign of hypokalemia in a patient with cirrhosis?

    <p>Increased thirst (A)</p> Signup and view all the answers

    What is a key aspect of nursing care for a patient with hepatic encephalopathy?

    <p>Monitoring the patient's neurologic status frequently (A)</p> Signup and view all the answers

    What is a common complication associated with cirrhosis that can lead to life-threatening bleeding?

    <p>Bleeding varices (C)</p> Signup and view all the answers

    Which nursing intervention is important in managing a patient with bleeding varices?

    <p>Maintaining the patient's airway (C)</p> Signup and view all the answers

    Which of the following nursing interventions is appropriate for a patient with cirrhosis who is experiencing abdominal discomfort?

    <p>Both B and C (A)</p> Signup and view all the answers

    What is a common assessment finding in a patient with cirrhosis and jaundice?

    <p>Dark brown urine and gray or tan stool (B)</p> Signup and view all the answers

    Which of the following statements is TRUE about ascites in a patient with cirrhosis?

    <p>Accurate measurement of abdominal girth helps monitor the severity of ascites (B)</p> Signup and view all the answers

    What is a common nursing intervention for a patient with cirrhosis who is taking diuretics?

    <p>Both A and C (D)</p> Signup and view all the answers

    What nursing intervention is essential for a patient with cirrhosis who is experiencing altered body image?

    <p>Providing education and support regarding their condition (D)</p> Signup and view all the answers

    When a balloon tamponade is used for bleeding varices, what is a priority nursing intervention?

    <p>Checking the patency of the balloons regularly (C)</p> Signup and view all the answers

    What is the primary rationale for encouraging fluids in patients with cirrhosis?

    <p>To prevent dehydration and support overall health. (D)</p> Signup and view all the answers

    Which medication should be monitored closely in patients due to the risk of diarrhea and electrolyte loss?

    <p>Lactulose (A)</p> Signup and view all the answers

    What is an important lifestyle change for patients with cirrhosis attributed to chronic alcohol use?

    <p>Abstaining from alcohol. (A)</p> Signup and view all the answers

    Why is it crucial for patients and caregivers to understand the need for continual health care?

    <p>To manage potential life-threatening complications and ensure timely intervention. (C)</p> Signup and view all the answers

    What type of community support program is recommended for patients dealing with chronic alcohol use?

    <p>Alcoholics Anonymous (A)</p> Signup and view all the answers

    What is a critical aspect of home care for a patient with cirrhosis?

    <p>Helping the patient with activities of daily living while ensuring wellness. (C)</p> Signup and view all the answers

    What should patients be educated about regarding potential complications of cirrhosis?

    <p>When to seek medical attention and signs of complications. (D)</p> Signup and view all the answers

    Which of the following outcomes is expected for a patient with cirrhosis?

    <p>Have normal fluid and electrolyte balance. (A)</p> Signup and view all the answers

    Study Notes

    Cirrhosis: Overview

    • Cirrhosis is the final stage of liver disease, marked by extensive liver cell damage and replacement with scar tissue (fibrosis) and regenerative nodules.
    • It typically develops after many years of chronic liver disease.

    Etiology and Pathophysiology

    • Common causes in the US include chronic hepatitis C virus (HCV) infection, non-alcoholic steatohepatitis (NASH), and alcohol-induced liver disease. Malnutrition exacerbates alcohol-related cirrhosis.
    • Other causes include extreme dieting, malabsorption, and obesity.
    • Chronic inflammation and cell death (necrosis) from viral hepatitis lead to progressive fibrosis and cirrhosis. Alcohol use synergistically accelerates liver damage when combined with chronic hepatitis.
    • Biliary causes include primary biliary cholangitis (PBC) and primary sclerosing cholangitis (PSC).
    • Cardiac cirrhosis is a result of long-term severe right-sided heart failure, causing liver congestion, damage, and fibrosis.

    Pathogenesis of Cirrhosis

    • Liver cells attempt disorganized regeneration, leading to abnormal blood vessel and bile duct structures.
    • Excessive fibrous connective tissue disrupts normal liver lobules, causing irregular size/shape and hindering blood flow.
    • Eventually decreased liver function due to poor blood flow, nutrition, and hypoxia (low oxygen).

    Clinical Manifestations

    Early Manifestations

    • Often asymptomatic.
    • Symptoms may include fatigue, or an enlarged liver.
    • Liver function tests may be normal (compensated cirrhosis).

    Late Manifestations

    • Result from liver failure and portal hypertension.
    • Symptoms include jaundice, peripheral edema, and ascites.
    • Other manifestations include skin lesions, hematologic problems, endocrine problems, and peripheral neuropathy.
    • In advanced stages, the liver is small and nodular with greatly impaired function.

    Manifestations of Cirrhosis (Specific Aspects)

    • Jaundice: Decreased bilirubin excretion into the intestines due to compression of bile ducts by scar tissue, elevated bilirubin levels, ranging from mild to severe.
    • Skin Lesions: Spider angiomas (telangiectasia) and palmar erythema, caused by elevated estrogen levels due to impaired liver hormone metabolism.
    • Hematologic Problems: Thrombocytopenia, leukopenia, anemia, and coagulation problems (due to portal hypertension and splenomegaly). Impaired clotting factors and poor blood cell production also contribute.
    • Ascites: Accumulation of fluid in the abdominal cavity due to portal hypertension, hypoalbuminemia (low albumin), and hyperaldosteronism. Symptoms include abdominal distension, weight gain, and possible umbilicus eversion.
    • Peripheral Edema: Swelling in lower extremities, potentially present before or with ascites.
    • Splenomegaly: Enlargement of the spleen due to portal hypertension, leading to increased removal of blood cells.
    • Varices: Enlarged, fragile veins, especially esophageal and gastric, caused by portal hypertension. Risk of severe hemorrhaging.
    • Endocrine Problems: Altered hormone metabolism leads to gynecomastia, testicular atrophy, loss of body hair, menstrual irregularities in women, and increased/decreased hormone levels.
    • Peripheral Neuropathy: Commonly seen in alcoholic cirrhosis, possibly as a result of deficiencies of thiamine, folic acid, and cobalamin.
    • Hepatic encephalopathy: Neuropsychiatric manifestation with symptoms ranging from sleep problems to coma. Caused by elevated ammonia levels (due to impaired liver function) crossing the blood-brain barrier.
    • Hepatorenal syndrome: Renal failure (azotemia, oliguria) associated with cirrhosis, resulting from complications of portal hypertension, vasodilation, and decreased blood volume.

    Diagnostic Studies

    • Liver function tests (abnormal in various ways)
    • Liver biopsy: gold standard for diagnosis
    • Ultrasound/Fibroscan: detects cirrhosis but isn't as definitive.

    Management & Treatment

    • Goals: Slow cirrhosis progression, prevent complications, and maintain normal lifestyle.
    • Conservative Therapy:
      • Rest
      • B vitamins
      • Avoid alcohol and hepatotoxic drugs (like acetaminophen in high doses)
    • Specific Treatment:
      • Ascites: Sodium restriction, diuretics (spironolactone, furosemide), paracentesis (fluid removal).
      • Esophageal & Gastric Varices: Endoscopic banding/sclerotherapy, balloon tamponade, TIPS (transjugular intrahepatic portosystemic shunt), beta-blockers, octreotide, vasopressin.
      • Hepatic Encephalopathy: Antibiotics (rifaximin), lactulose, manage risk factors (GI bleeding)
      • Nutrition: High-calorie, high-carbohydrate, moderate-low fat diet for most; protein supplements for alcoholic cirrhosis; low-sodium diet for ascites/edema.
      • Nursing Interventions: Monitor vital signs, intake/output, weight, skin, fluid & electrolyte balance, monitor for complications and bleeding, support, explanations to the patient.

    Complications

    • Portal hypertension
    • Esophageal and gastric varices
    • Peripheral edema
    • Abdominal ascites
    • Hepatic encephalopathy
    • Hepatorenal syndrome
    • Compensated vs. decompensated cirrhosis

    Prevention and Early Treatment

    • Identifying and mitigating risk factors (alcohol use, malnutrition, viral hepatitis, etc.)
    • Promoting early and adequate nutrition, especially for those at risk.
    • Treating acute hepatitis to prevent progression to chronic liver disease.

    Ambulatory Care

    • Longterm management, health education, and community support programs (like Alcoholics Anonymous)
    • Emphasizes lifestyle changes, especially alcohol abstinence.

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    Description

    Test your knowledge on cirrhosis, including its characteristics, causes, and effects on the body. This quiz covers common symptoms, complications, and the role of factors like alcohol and blood flow in the development of cirrhosis. Perfect for students and healthcare professionals alike.

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