When is liver transplant curative? What is the best management option for esophageal varices? And, is hepatorenal failure to blame here? Test your hepatic management know-how.
#1. Liver transplantation is reserved for patients with end stage liver disease, without a reasonable chance for recovery. Which of the diseases above does not recur after liver transplantation?
Answer: D. Alpha-1 antitrypsin (AAT) deficiency. AAT is an inherited disorder that may cause lung disease and liver disease. The signs and symptoms of the condition and the age at which they appear vary among individuals.
#2. A 59-year-old man with non-alcoholic steatohepatitis leading to cirrhosis undergoes a screening endoscopy which reveals large esophageal varices without gastric varices; nadolol is initiated as prophylaxis. One month later he is normotensive with HR of 54 beats/min. What is the next best step in management?
Answer: C. Continue current management. Primary prophylaxis for large varices can include nonselective beta blockade or endoscopic band ligation.
#3. A 42 year-old woman with alcoholic cirrhosis presents to the ED via ambulance after being found unresponsive in her home. Based on the exam and laboratory results above which demonstrate kidney injury, what is the next best step in management?
Answer: C. IV fluids and antibiotics. Not all renal failure in patients with cirrhosis is due to hepatorenal syndrome. It is important to recognize other causes, such as volume depletion in the setting of sepsis secondary to urinary tract infection, as is the case with this patient.
