Cirrhosis: Pathophysiology and Pharmacotherapy Review
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Questions and Answers

What is the maximum dose of propranolol for varices treatment in patients with ascites?

  • 80mg/day
  • 40mg/day
  • 320mg/day (correct)
  • 160mg/day

Which medication is titrated every 2-3 days up to 80mg/day (ascites) or 160mg/day (no ascites) for varices treatment?

  • Propranolol
  • Labetalol
  • Nadolol (correct)
  • Carvedilol

How often is endoscopic variceal ligation done until eradication of varices?

  • Once a year
  • Every 3-6 months
  • Every month
  • Every 2-8 weeks (correct)

What is the high risk event in cirrhosis patients with an underlying coagulopathy and HVPG > 20mmHg?

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

What is the initial treatment for a cirrhosis patient presenting with acute major bleeding?

<p>Volume resuscitation with PRBCs (A)</p> Signup and view all the answers

What is the primary cause of thrombocytopenia/neutropenia in cirrhosis patients?

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

Which factor leads to an increased risk of bleeding as cirrhosis progresses?

<p>Decreased clotting factor production (A)</p> Signup and view all the answers

What is the drug of choice for long-term prophylaxis in a cirrhosis patient who has had one occurrence of spontaneous bacterial peritonitis (SBP)?

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

In advanced liver disease, what leads to eventual depletion of storage and release of glucose in the liver?

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

What affects the absorption of drugs in patients with advanced cirrhosis?

<p>Decreased gastric blood flow (A)</p> Signup and view all the answers

Which type of hepatorenal syndrome is defined as SCr>2.5mg/dL or 50% reduction in CrCl?

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

What medications should be avoided in patients with advanced cirrhosis due to their significant liver metabolism?

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

Which of the following is a common complication seen in liver failure?

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

What is used to determine cirrhosis disease severity?

<p>Child-Pugh classification (A)</p> Signup and view all the answers

Which of the following is a pharmacologic plan for esophageal varices prophylaxis in cirrhosis?

<p>Initiating beta-blockers (B)</p> Signup and view all the answers

What is a commonly used non-pharmacologic intervention in the treatment of ascites in cirrhosis?

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

Which of the following is an evaluation for prophylaxis in spontaneous bacterial peritonitis (SBP)?

<p>Primary antibiotic prophylaxis (A)</p> Signup and view all the answers

What is used to calculate a MELD score to determine cirrhosis disease severity?

<p>Bilirubin, albumin, and creatinine levels (D)</p> Signup and view all the answers

Which laboratory abnormality is commonly encountered in cirrhosis?

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

What is a possible treatment regimen for hepatic encephalopathy in cirrhosis?

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

Which is the most common form of liver disease not associated with alcohol?

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

What is the irreversible fibrosis of the liver called?

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

What is the major goal for the treatment of portal hypertension?

<p>Prevention of bleeding (C)</p> Signup and view all the answers

What is used to grade the risk of mortality for cirrhotic patients based on clinical evaluation and lab values?

<p>Child-Pugh score (A)</p> Signup and view all the answers

What is the mainstay of therapy for NAFLD risk stratification and treatment?

<p>Lifestyle modifications and medications (B)</p> Signup and view all the answers

What are the two clinical stages of cirrhosis based on the presence or absence of complications?

<p>Compensated and decompensated stages (D)</p> Signup and view all the answers

What is the major cause of portal hypertension?

<p>Repetitive injury to hepatocytes (C)</p> Signup and view all the answers

What predicts 3-month mortality for end-stage liver disease patients?

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

Which liver disease can progress to cirrhosis and hepatocellular carcinoma?

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

What are the major complications of cirrhosis treatment?

<p>Drug interactions, hepatic encephalopathy, etc. (C)</p> Signup and view all the answers

What are the goals of NAFLD risk stratification and treatment?

<p>Preventing disease progression, promoting regression, managing comorbidities (C)</p> Signup and view all the answers

Study Notes

  • Coagulopathy and acute treatment for bleeding complications in cirrhotic patients: review principles and evaluate patient case based on severity
  • Liver function: filtration/toxin clearance, metabolism, digestion, protein production/synthesis, storage
  • Cirrhosis: irreversible fibrosis of the liver, 8th leading cause of death in US, causes include hepatitis B and C, alcohol abuse, NAFLD, gallstones/biliary obstructions, medications.
  • NAFLD: most common form of liver disease not associated with alcohol, diagnosed often asymptomatically, can progress to cirrhosis and hepatocellular carcinoma.
  • NAFLD risk stratification and treatment: goals include preventing disease progression, promoting regression, managing comorbidities. Lifestyle modifications and medications are mainstays of therapy.
  • Cirrhosis progression: repeated injury to hepatocytes leads to hepatocyte inflammation, fat deposits, hepatocyte death, nodule formation, collagen deposition, and fibrosis. Two clinical stages: compensated and decompensated based on presence or absence of complications.
  • Clinical presentation: asymptomatic until advanced disease, hepatomegaly and splenomegaly, jaundice/scleral icterus, asterixis, pruritis, erythema, spider angiomas.
  • Lab findings: hepatic damage, filtration/toxin clearance issues, synthetic dysfunction, coagulation abnormalities, anemia, thrombocytopenia, bone marrow suppression, hyperammonemia.
  • Diagnostics: ultrasound, CT scan, MRI, angiography, ERCP, biopsy.
  • Cirrhosis complications: portal hypertension, varices and variceal bleeding, hepatic encephalopathy, ascites, spontaneous bacterial peritonitis, coagulopathy, hepatorenal syndrome, hypoglycemia, drug metabolism considerations, etc.
  • Portal hypertension: caused by repetitive injury to hepatocytes, major complications include varices, ascites, splenomegaly.
  • Portal hypertension treatment: non-selective beta-blockers for prevention of variceal bleeding, goal for treatment is prevention of bleeding, HVPG reduced below 12mmHg or >20% decrease from baseline.
  • Child-Pugh score: used to grade risk of mortality for cirrhotic patients, based on clinical evaluation and lab values.
  • MELD model: predicts 3 month mortality for end stage liver disease patients.
  • Cirrhosis treatment: lifestyle modifications, medications, surgery.
  • Complications of cirrhosis treatment: drug interactions, bleeding risk, hepatic encephalopathy, etc.

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Description

This quiz covers the review of liver function, complications in liver failure, definition, pathophysiology, clinical presentation, laboratory abnormalities in cirrhosis, Child-Pugh classification, MELD score calculation and pharmacologic planning for esophageal issues in cirrhosis.

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