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INSTRUCTIONS Cirrhosis: An evidence-based treatment approach



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Cirrhosis: An evidence-based treatment approach


General Purpose: To provide information about the prevalence, pathophysiology, diagnosis, and complications of cirrhosis with an evidence-based approach to disease management. Learning Objectives/Outcomes: After completing this learning activity, you should be able to: 1. Identify prevalence, pathophysiology, diagnosis, and recommended testing for patients with cirrhosis. 2. Describe decompensation, complications, and evidence-based practices for management of cirrhosis.


1. Which statement accurately represents the prevalence of cirrhosis within the US?


a. Prevalence data are falsely elevated due to overdiagnosis.


b. Disease rates are higher for low-income and Black populations.


c. The number of cirrhosis diagnoses has steadily declined over the past 20 years.


2. As compared with other types of chronic diseases, cirrhosis has a (an)


a. equivalent risk of mortality.


b. lower risk of mortality.


c. higher risk of mortality.


3. In the US, cirrhosis usually occurs due to an inciting event such as a (an)


a. viral infection.


b. bacterial infection.


c. autoimmune disease.


4. When early fibrosis is present, removing the event that caused the liver damage


a. may accelerate a rapid disease progression.


b. can lead to possible regression and recovery.


c. does not reduce the damage, and transplant is usually needed.


5. Recent data addressing cirrhosis reveal that patients are now being diagnosed at


a. younger ages than in past decades.


b. older ages than in the 1980s or 1990s.


c. the sixth or seventh decade of life.


6. Hepatic vasculature is altered due to cirrhosis-related changes. These vascular changes in the hepatic system lead to an increase in


a. hepatic blood flow.


b. portal venous pressure.


c. lysis of thrombi in the portal vein.


7. A patient is moving into decompensated cirrhosis after being in a compensated state for many years. When decompensation occurs, a common complication is


a. ascites.


b. portal hypotension.


c. reduced bilirubin levels.


8. Once a patient develops decompensated cirrhosis, life expectancy


a. decreases to approximately 2 years.


b. increases by an additional 10 years.


c. remains unchanged from the compensated state.


9. When assessing the ability of a patient's liver to function properly, one of the true "liver function tests" that should be ordered is


a. ALT.


b. AST.


c. PT/INR.


10. A patient is in a late stage of decompensated cirrhosis. It is anticipated that lab findings will most likely include an elevation of


a. PT/INR.


b. albumin.


c. platelets.


11. A test that is considered the gold standard for diagnosis of fibrosis and cirrhosis includes


a. a liver biopsy.


b. serum biomarkers.


c. a transient liver elastography test.


12. A patient who has developed ascites is advised that management of this complication will include


a. paracentesis.


b. prescribing three diuretics.


c. dietary sodium restriction of 3,000 mg per day.


13. To provide renal protection from volume loss when removing more than 5 L of fluid, the procedure of paracentesis should be followed by


a. beta-blockers.


b. lactulose therapy.


c. an albumin infusion.


14. The complication of HE can occur due to


a. portosystemic shunting.


b. the delivery of ammonia to hepatocytes.


c. excess accumulation of potassium in the blood.


15. The focus of treatment for a patient's HE diagnosis is to


a. start beta-blockers to prevent bleeding.


b. initiate lactulose to reduce absorption of ammonia.


c. use a potassium-sparing diuretic and a loop diuretic together.


16. A patient was diagnosed with cirrhosis 9 months ago. The clinician is now recommending an EGD to screen for


a. hepatorenal syndrome.


b. hepatopulmonary syndrome.


c. gastric and esophageal varices.


17. A patient is diagnosed with hepatopulmonary syndrome. The only effective treatment for this diagnosis is


a. liver transplant.


b. chemoembolization.


c. radiofrequency ablation.


18. To predict severity of disease and risk for poor outcomes, the MELD-Na Score uses all of the following except


a. bilirubin levels.


b. creatinine levels.


c. glomerular filtration rate.


19. When prescribing a medication to treat the comorbidity of anxiety, the safest choice for patients with cirrhosis is


a. benzodiazepines.


b. diphenhydramine.


c. selective serotonin reuptake inhibitors.


20. Due to the presence of a hypermetabolic state, which of the following would be the better meal choice for a patient with cirrhosis?


a. steak, lentils, and a peanut butter sandwich


b. vegetable risotto, guacamole, and a green salad


c. spaghetti and tomato sauce with a fresh fruit smoothie