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Management of patients with complications of cirrhosis

doi: 10.1097/01.NPR.0000428852.22728.41
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INSTRUCTIONS Management of patients with complications of cirrhosis


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Management of patients with complications of cirrhosis

General Purpose: To provide information on managing patients with complications of cirrhosis. Learning Objectives: After reading the preceding article and taking this test, you should be able to: 1. Describe the pathophysiology and diagnosis of cirrhosis and the staging of cirrhosis complications. 2. Discuss risk factors for complications of cirrhosis and treatment options.

  1. End-stage liver disease is characterized by a(n)
    1. increase in cardiac output.
    2. increase in arterial BP.
    3. decrease in heart rate>.
    4. increase in systemic vascular resistance.
  2. The splanchnic and peripheral vasodilation from end-stage liver disease results in
    1. decreased stimulation of the renin-angiotensin-aldosterone system.
    2. reduced secretion of antidiuretic hormone.
    3. diminished renal blood flow.
    4. increased sodium excretion.
  3. Lab results for patients with cirrhosis include
    1. hyperalbuminemia.
    2. thrombocytosis.
    3. decreased PMN count.
    4. prolonged INR.
  4. Which of the following is not a diagnostic criterion of decompensated cirrhosis?
    1. ascites
    2. jaundice
    3. hepatic encephalopathy
    4. variceal bleeding
  5. When the SAAG is 1.1 g/dL or greater, ascites is likely related to
    1. pancreatitis.
    2. nephrotic syndrome.
    3. peritoneal carcinomatosis.
    4. portal hypertension.
  6. Moderate ascites with abdominal distension is classified as
    1. stage 1.
    2. stage 2.
    3. stage 3.
    4. refractory.
  7. Treatment of ascites commonly involves
    1. spironolactone and furosemide.
    2. 1 to 1.5 g/day sodium restriction.
    3. spironolactone and amiloride.
    4. norfloxacin or trimethoprim-sulfamethoxazole.
  8. After placement of a TIPS, there is a chance of developing
    1. HRS.
    2. SBP.
    3. hepatic encephalopathy.
    4. variceal bleeding.
  9. The treatment of choice for SBP is
    1. norfloxacin.
    2. amoxicillin-clavulanate.
    3. neomycin.
    4. cefotaxime.
  10. The development of hepatic encephalopathy is most often attributed to a high level of
    1. sodium.
    2. ammonia.
    3. potassium.
    4. urea.
  11. Hepatic encephalopathy characterized by somnolence to semi-stupor is
    1. grade 1.
    2. grade 2.
    3. grade 3.
    4. grade 4.
  12. A safer and equally effective alternative to neomycin for treating hepatic encephalopathy is
    1. rifaximin.
    2. cefotaxime.
    3. midodrine.
    4. octreotide.
  13. Malnourished patients with cirrhosis commonly are deficient in all of the following except
    1. zinc.
    2. selenium.
    3. sodium.
    4. magnesium.
  14. The main treatment for esophageal varices includes
    1. amiloride.
    2. octreotide.
    3. albumin.
    4. beta blockers.
  15. Immediate treatment of variceal rupture includes
    1. liver transplantation.
    2. administration of blood products.
    3. large volume paracentesis.
    4. vigorous resuscitation with 0.9% sodium chloride.
  16. An event that may trigger type 1 HRS is
    1. nonsteroidal anti-inflammatory drug administration.
    2. large volume paracentesis with the administration of albumin.
    3. stage 1 ascites.
    4. administration of midodrine.
  17. Major criteria for the diagnosis of HRS in patients with cirrhosis include
    1. hypovolemic shock.
    2. recent treatment with nephrotoxic drugs.
    3. presence of parenchymal kidney disease.
    4. serum creatinine greater than 1.5 mg/dL.
  18. A risk factor for HCC is
    1. prolonged corticosteroid use.
    2. chronic hepatitis C.
    3. peritonitis.
    4. sepsis.


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