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OST 575 Exam 3 |Questions with 100% Correct Answers
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OST 575 Exam 3 |Questions with 100% CorrectAnswers
Palmar erythema - ✔️✔️-Erythema sparing central portion of palm
-Due to elevated estradiol
-Clinical sign of cirrhosis
Gold standard for dx of cirrhosis - ✔️✔️Liver biopsy
Portal HTN - ✔️✔️-Increase in hepatic venous pressure gradient
-In cirrhosis, occurs through increase in resistance to portal venous outflow due to liver
distortion
Ascites - ✔️✔️-Renal retention of Na+ and movement of fluid into peritoneal space
(Hyperaldosteronism)
-Increased abdominal girth
-Also due to splanchnic vasodilation
Ascites dx - ✔️✔️-Imaging
-Fluid wave
-*Paracentesis*
-SAAG: Gradient >1.1 is due to portal HTN causes
Ascites prevention - ✔️✔️-Low sodium diet
-Bedrest is beneficial bc upright posture increases aldosterone levels
Spontaneous bacterial peritonitis - ✔️✔️-Acute bacterial infection of ascitic fluid
,-Most commonly caused by *E. coli*
Dx: Paracentesis. Must have high index of suspicion
Tx: Cephalosporins. Prophylaxis.
Hepatic encephalopathy - ✔️✔️-Alteration in mental status and cognitive function due to gut-
derived neurotoxins
-*High ammonia*
-Sx: Neurologic signs (*asterixis*), insomnia, hypersomnia
Management of acute variceal bleed - ✔️✔️1. Resuscitation
2. Vasoconstrictors (Octreotide)
3. Sclerotherapy or band ligation
4. Transjugular intrahepatic portosystemic shunt (TIPS)
-Reduce risk of bleeding w/ prophylactic therapy (propanolol)
Coagulopathy in cirrhosis - ✔️✔️-Decreased synthesis of clotting factors due to portal HTN
How do you tell if coagulopathy is due to nutrition or cirrhosis? - ✔️✔️-If nutritional, it will
improve w/ Vit K replacement
-If cirrhotic, PT/INR won't improve
Vit K dependent clotting factors - ✔️✔️2, 7, 9, 10
Main precipitous in cirrhosis - ✔️✔️Portal HTN
,Management of cirrhosis - ✔️✔️-Slowing or reversing progression of liver disease
-Managing sx and lab abnormalities
-Preventing, identifying, and treating the complications of cirrhosis
-*Definitive tx = Liver transplant*
Primary liver cancer etiology - ✔️✔️-More common in males
-Hep B - Asia, Africa
-Cirrhosis
Primary liver cancer sx - ✔️✔️-Epigastric fullness
-RUQ mass
-Pts w/ cirrhosis: Unexpected clinical deterioration
-Paraneoplastic syndrome (polycythemia, hypercalcemia)
Primary liver cancer dx - ✔️✔️-Needle biopsy is definitive
-Liver scan - CT
-*Increased serum alpha fetoprotein*
-Increased LFTs
Most common site for liver cancer to metastasize to - ✔️✔️Lungs
Primary liver cancer tx - ✔️✔️-Surgery is tx of choice
-Radiation/Chemo
-Poor prognosis - 4 to 6 months survival
, Most common cancer to cause metastatic liver cancer - ✔️✔️*Colorectal* (sites that are drained
by portal v)
Metastatic liver cancer dx - ✔️✔️-Needle biopsy
-CT scan
-LFT's
-*CEA* is good for monitoring response to therapy, not dx
Most common causes of liver transplant - ✔️✔️-Hep C (in US)
-HCC
-EtOH
In children - biliary atresia
Most common cause of liver transplant in children - ✔️✔️Biliary atresia
Indication for liver transplant - ✔️✔️-Irreversible acute or chronic liver disease
-No contraindications
-Willingness
Absolute contraindications to liver transplant - ✔️✔️-Extrahepatic malignancy
-Active sepsis
-Advanced cardiopulmonary disease
-Active alcoholism or substance abuse
-AIDS
Evidence of hepatic synthetic dysfunction - ✔️✔️-Prolonged PT/INR
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