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 patient with alcoholic cirrhosis presents with acute upper GI bleeding. Endoscopy shows actively bleeding esophageal varices treated with band ligation. Which medication should be started immediately upon admission?
Answer: Octreotide IV infusion
Octreotide (or terlipressin) reduces splanchnic blood flow and portal pressure; it should be started at admission and continued for 3–5 days during acute variceal hemorrhage.
Which of the following is the strongest independent risk factor for spontaneous bacterial peritonitis (SBP) in cirrhotic patients with ascites?
Answer: Ascitic fluid protein <1.5 g/dL
Low ascitic fluid protein (<1.5 g/dL) reflects reduced opsonic activity and is the strongest independent risk factor for SBP in cirrhotic ascites.
A cirrhotic patient with known varices has not bled. What is the recommended primary prophylaxis approach for large varices?
Answer: Non-selective beta-blockers or endoscopic band ligation
Non-selective beta-blockers (propranolol, nadolol, carvedilol) or endoscopic band ligation are equally effective first-line primary prophylaxis for large esophageal varices.
A patient with cirrhosis and hepatic encephalopathy is found to have hyponatremia (Na 121 mEq/L). Which treatment is most appropriate?
Answer: Fluid restriction and consideration of vaptans
Dilutional hyponatremia in cirrhosis is managed with fluid restriction; vasopressin receptor antagonists (vaptans) may be used in resistant cases.
Which complication of cirrhosis is characterized by intrapulmonary vascular dilatations leading to hypoxemia that improves with 100% oxygen administration?
Answer: Hepatopulmonary syndrome
Hepatopulmonary syndrome results from intrapulmonary vasodilation causing V/Q mismatch and right-to-left shunting, with PaO2 improving on 100% O2.
A cirrhotic patient with tense ascites undergoes large-volume paracentesis (5 liters removed) without albumin infusion. What complication is most likely to occur within 6 hours?
Answer: Paracentesis-induced circulatory dysfunction
Paracentesis-induced circulatory dysfunction (PICD) occurs when >5L is removed without albumin replacement, causing plasma renin activation and renal/circulatory compromise.
Which finding on ascitic fluid analysis most reliably distinguishes SBP from secondary bacterial peritonitis?
Answer: Ascitic fluid protein >1 g/dL with multiple organisms
Secondary peritonitis typically shows multiple organisms on culture, high protein, high LDH, and low glucose in ascitic fluid, distinguishing it from SBP.