Pathophys
_____________ is an infection of ascitic fluid without an obvious intra-abdominal source. It occurs most commonly in cirrhotic patients with ascites due to bacterial translocation from the gut into ascitic fluid.
Answer: Spontaneous bacterial peritonitis
Confirmed via paracentesis, with an ascitic fluid neutrophil count >250 PMN/mm3.
______________ presents as confusion, altered mental status, sleep disturbances, asterixis (“liver flap”), and disorientation/coma in severe cases.
Answer: Hepatic encephalopathy
___________ is the best treatment option for hepatorenal syndrome.
Answer: Transplantation. Otherwise, first-line treatment is terlipressin + albumin
Terlipressin acts as a vasoconstrictor to improve renal perfusion, while albumin provides volume expansion.
_____________ is a functional renal failure that occurs in advanced cirrhosis with portal hypertension and severe systemic vasodilation. Splanchnic vasodilation decreases effective arterial blood volume, activating RAAS and sympathetic systems, which causes intense renal vasoconstriction and reduced kidney perfusion.
Answer: Hepatorenal syndrome
Renal failure in the setting of avid sodium retention and adequate intravascular volume repletion. Sign of very advanced disease.
______________ presents as fever, abdominal pain/tenderness, altered mental status, worsening ascites, may present subtly in cirrhotic patients.
Answer: Spontaneous bacterial peritonitis
___________ is first-line treatment for hepatic encephalopathy.
Answer: Lactulose + Rifaximin
Lactulose acidifies the colon and traps ammonia as ammonium. Rifaximin decreases ammonia-producing gut bacteria.
______________ is a neuropsychiatric complication of advanced liver disease caused by the liver’s inability to detoxify substances—especially ammonia.
Answer: Hepatic encephalopathy
In cirrhosis or liver failure, ammonia produced by gut bacteria bypasses the damaged liver through portosystemic shunting and enters systemic circulation. Elevated ammonia and other neurotoxins alter neurotransmission and cause astrocyte swelling and cerebral dysfunction.
______________ presents as rising creatinine, oliguria, advanced cirrhosis with ascites, low urine sodium, and no improvement with IV fluids.
Answer: Hepatorenal syndrome
___________ are first-line treatment for Sponatenous bacterial peritonitis.
Answer: Third-generation cephalosporins (such as ceftriaxone or cefotaxime)
Adjunctive treatments can include IV albumin to reduce risk of hepatorenal syndrome or prophylactic antibiotics such as Norfloxacin or TMP-SMX in high-risk patients