Chronic Liver Disease Complications Flashcards
7 cards from real Internal Medicine Exam practice questions. Tap to flip, then mark Knew It or Still Learning — missed cards come back until you master them.
Read the first 7 Chronic Liver Disease Complications flashcards as text
A cirrhotic patient develops confusion and asterixis after a high-protein meal. Serum ammonia is elevated. Which neurotransmitter system is most implicated in hepatic encephalopathy?
Answer: GABAergic system
Elevated ammonia enhances GABAergic neurotransmission, promoting inhibitory tone and causing hepatic encephalopathy.
A patient with cirrhosis has ascites refractory to diuretics. Diagnostic paracentesis shows SAAG of 1.8 g/dL. What is the most appropriate next management step?
Answer: Large-volume paracentesis with albumin infusion
Refractory ascites is managed with large-volume paracentesis (LVP) plus IV albumin (6–8 g per liter removed) to prevent paracentesis-induced circulatory dysfunction.
Which Child-Pugh score component best correlates with the severity of synthetic liver dysfunction?
Answer: Prothrombin time/INR
Prothrombin time/INR reflects hepatic synthesis of clotting factors and is the most direct measure of synthetic dysfunction in the Child-Pugh score.
A cirrhotic patient with esophageal varices is started on non-selective beta-blocker therapy. Which parameter best confirms adequate pharmacologic response?
Answer: Hepatic venous pressure gradient (HVPG) <12 mmHg or ≥20% reduction
Adequate beta-blocker response is confirmed by HVPG reduction to <12 mmHg or ≥20% from baseline, which significantly reduces variceal bleeding risk.
A patient with decompensated cirrhosis develops oliguria, rising creatinine, and a FENa <0.01% despite adequate volume status. Urine microscopy is bland. What is the most likely diagnosis?
Answer: Hepatorenal syndrome type 1
HRS type 1 presents with rapidly progressive renal failure, FENa <0.01%, bland urine sediment, and normal renal parenchyma in a cirrhotic patient without alternative cause.
Which scoring system is currently used to prioritize liver transplant candidates in the United States?
Answer: MELD-Na score
The MELD-Na score (incorporating sodium, bilirubin, INR, and creatinine) is used by UNOS to prioritize liver transplant allocation in the US.
A cirrhotic patient on lactulose for hepatic encephalopathy develops diarrhea and worsening confusion. Serum sodium is 128 mEq/L. What is the most appropriate adjustment?
Answer: Reduce lactulose dose and add rifaximin
Diarrhea from lactulose can cause dehydration and electrolyte disturbances that worsen encephalopathy; reducing the dose and adding rifaximin is the preferred adjustment.