31 Questions
What is the maximum dose of propranolol for varices treatment in patients with ascites?
320mg/day
Which medication is titrated every 2-3 days up to 80mg/day (ascites) or 160mg/day (no ascites) for varices treatment?
Nadolol
How often is endoscopic variceal ligation done until eradication of varices?
Every 2-8 weeks
What is the high risk event in cirrhosis patients with an underlying coagulopathy and HVPG > 20mmHg?
Variceal bleeding
What is the initial treatment for a cirrhosis patient presenting with acute major bleeding?
Volume resuscitation with PRBCs
What is the primary cause of thrombocytopenia/neutropenia in cirrhosis patients?
Splenomegaly
Which factor leads to an increased risk of bleeding as cirrhosis progresses?
Decreased clotting factor production
What is the drug of choice for long-term prophylaxis in a cirrhosis patient who has had one occurrence of spontaneous bacterial peritonitis (SBP)?
Oral ciprofloxacin
In advanced liver disease, what leads to eventual depletion of storage and release of glucose in the liver?
'Hypoglycemia'
What affects the absorption of drugs in patients with advanced cirrhosis?
Decreased gastric blood flow
Which type of hepatorenal syndrome is defined as SCr>2.5mg/dL or 50% reduction in CrCl?
Type I
What medications should be avoided in patients with advanced cirrhosis due to their significant liver metabolism?
NSAIDs
Which of the following is a common complication seen in liver failure?
Esophageal varices
What is used to determine cirrhosis disease severity?
Child-Pugh classification
Which of the following is a pharmacologic plan for esophageal varices prophylaxis in cirrhosis?
Initiating beta-blockers
What is a commonly used non-pharmacologic intervention in the treatment of ascites in cirrhosis?
Paracentesis
Which of the following is an evaluation for prophylaxis in spontaneous bacterial peritonitis (SBP)?
Primary antibiotic prophylaxis
What is used to calculate a MELD score to determine cirrhosis disease severity?
Bilirubin, albumin, and creatinine levels
Which laboratory abnormality is commonly encountered in cirrhosis?
Thrombocytopenia
What is a possible treatment regimen for hepatic encephalopathy in cirrhosis?
Lactulose and/or rifaximin therapy
Which is the most common form of liver disease not associated with alcohol?
NAFLD
What is the irreversible fibrosis of the liver called?
Cirrhosis
What is the major goal for the treatment of portal hypertension?
Prevention of bleeding
What is used to grade the risk of mortality for cirrhotic patients based on clinical evaluation and lab values?
Child-Pugh score
What is the mainstay of therapy for NAFLD risk stratification and treatment?
Lifestyle modifications and medications
What are the two clinical stages of cirrhosis based on the presence or absence of complications?
Compensated and decompensated stages
What is the major cause of portal hypertension?
Repetitive injury to hepatocytes
What predicts 3-month mortality for end-stage liver disease patients?
MELD model
Which liver disease can progress to cirrhosis and hepatocellular carcinoma?
NAFLD
What are the major complications of cirrhosis treatment?
Drug interactions, hepatic encephalopathy, etc.
What are the goals of NAFLD risk stratification and treatment?
Preventing disease progression, promoting regression, managing comorbidities
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.
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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