Under Pressure
At what MELD-Na score should you consider a patient for liver transplant
15
Name at least two factors that are considered high-risk for advanced fibrosis
DM or pre-DM
obesity
2 cardiometabolic risk factors
steatosis on imaging
Elevated AST/ALT
This formula helps distinguish hepatocellular from cholestatic liver injury patterns
R factor
What is considered appropriate albumin replacement for large volume paracentesis
6-8g/L removed
This classification distinguishes subtle cognitive dysfunction from coma in cirrhotic patients.
overt vs covert hepatic encephalopathy
Clinically significant portal hypertension is considered HPVG >= ?? mmHg
10 mmHg
A fib-4 score greater than what number indicates high risk and need for immediate hepatology referral
2.67
INR is an unreliable predictor of bleeding risk in cirrhosis due to this concept
Rebalanced Hemostasis
what is the protein goal in patients with cirrhosis?
1.2-1.5 g/kg/day
Urobilinogen is bound by *** and transported to the liver
Name 2 non-invasive markers that can be used to assess portal hypertension
Platelet count and transient elastography
Fibrosis progression occurs roughly twice as fast in MASH compared to NAFLD at this rate.
Fibrosis advances every stage ~7 years
TWO PART:
what clotting factor is NOT synthesized by the liver and where is it instead produced?
Factor VIII
Made by endothelial cells
Loss of this percentage of body weight promotes regression of fibrosis
>= 10%
list 3 causes of non-hepatic hepatocellular injury
Skeletal muscle damage/rhabdo
cardiac muscle damage
Thyroid disease
Strenuous exercise
Heat stroke
Hemolysis
Adrenal insufficiency
Name two risks of TIPS
hepatic encephalopathy, HF
Aside from steatosis, name at least one other histologic finding in MASH
lobular inflammation
hepatocyte ballooning
perisinusoidal fibrosis
What part of the cell is ALT found in?
cytoplasm
What did the dietary RCT (Direct Plus trial) shows?
The new suggested strategy of green-Mediterranean diet, amplified with green plant-based proteins/polyphenols as Mankai, green tea, and walnuts, and restricted in red/processed meat can double IHF loss than other healthy nutritional strategies and reduce NAFLD in half.
What is the MOA of resmetirom
Resmetirom is a thyroid hormone receptor-beta agonist used to treat non-cirrhotic nonalcoholic steatohepatitis. Thyroid hormones directly regulate lipid metabolism in the liver; Resmetirom works to reduce liver fat by stimulating fatty acid degradation and oxidation
List 3 treatment options for HRS
Treat with albumin + vasoconstrictors
Terlipressin
Definitive therapy = liver transplant
What is the name of the trial that compared Vitamin E vs pioglitazone vs placebo in subjects with biopsy proven NASH
PIVENs Trial
Vitamin E was superior to placebo for the treatment of nonalcoholic steatohepatitis in adults without diabetes. There was no benefit of pioglitazone over placebo for the primary outcome; however, significant benefits of pioglitazone were observed for some of the secondary outcomes.
What is the name of the blood-based biomarker used to diagnose advanced fibrosis
Enhanced Liver Fibrosis (ELF) test
Name 3 categories of treatment for hepatic encephalopathy?
Lactulose and rifaximin
Embolization of spontaneous shunts
Liver Transplant
This genetic disease appears to be related to defective bilirubin storage by hepatocytes
Rotor syndrome