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 cirrhosis and grade 2 hepatic encephalopathy is precipitated by a GI bleed. After controlling the bleed, which intervention specifically targets ammonia reduction to treat the encephalopathy?
Answer: Lactulose titrated to 2–3 soft stools per day
Lactulose is the first-line treatment for hepatic encephalopathy; it acidifies the colon, traps ammonia as ammonium, and accelerates its fecal excretion.
Portal vein thrombosis (PVT) is found incidentally in a patient with cirrhosis. It is non-occlusive and asymptomatic. What is the most appropriate management?
Answer: Anticoagulation with low-molecular-weight heparin or direct oral anticoagulants
Anticoagulation is recommended for non-occlusive PVT in cirrhosis to prevent extension and promote recanalization, as the bleeding risk is generally outweighed by thrombosis risk.
Which antibiotic regimen is recommended for SBP prophylaxis in a cirrhotic patient with a prior episode of SBP?
Answer: Norfloxacin 400 mg daily (or trimethoprim-sulfamethoxazole)
Indefinite secondary prophylaxis with norfloxacin 400 mg/day or TMP-SMX is recommended after a first episode of SBP to prevent recurrence.
A cirrhotic patient develops portopulmonary hypertension (PoPH). Which finding on echocardiography is most consistent with this diagnosis?
Answer: Elevated right ventricular systolic pressure >50 mmHg with right heart strain
PoPH is characterized by pulmonary arterial hypertension in the setting of portal hypertension; echo shows elevated RVSP and right heart dilation/strain.
A patient with alcoholic cirrhosis has a prolonged INR of 2.4 but no active bleeding. Surgery is required for cholecystitis. Which intervention is most appropriate to assess true bleeding risk?
Answer: Measure thromboelastography (TEG) or rotational thromboelastometry (ROTEM)
INR in cirrhosis overestimates bleeding risk because it does not reflect the balanced reduction in both pro- and anticoagulant factors; viscoelastic testing (TEG/ROTEM) provides a more accurate assessment.
Zinc deficiency is common in cirrhosis. What is the most clinically relevant consequence of zinc deficiency in this population?
Answer: Impaired urea cycle function contributing to hyperammonemia
Zinc is an essential cofactor for urea cycle enzymes; deficiency impairs ammonia detoxification and can worsen hepatic encephalopathy.
A cirrhotic patient with refractory ascites is being evaluated for TIPS. Which condition is an absolute contraindication to TIPS placement?
Answer: Severe hepatic encephalopathy (grade 3–4) or severe hepatic dysfunction
Severe or refractory hepatic encephalopathy and advanced hepatic failure (Child-Pugh C >13 or MELD >18) are absolute contraindications to TIPS due to the risk of worsening encephalopathy and liver failure.