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Chapter 22. Portal Hypertension and Cirrhosis

Student Questions

Which of the following is the most common cause of cirrhosis worldwide?

A. Hepatitis A

B. Hepatitis B

C. Hepatitis C

D. Alcohol

Answer: B

Option A: Incorrect. Hepatitis A causes acute illness but not cirrhosis.

Option B: Correct. Hepatitis B is the most common cause of cirrhosis worldwide. It is not a leading cause in the United States because of high vaccination rates.

Option C: Incorrect. Hepatitis C is one of the leading causes, but it is not the most common cause.

Option D: Incorrect. Alcohol is a leading cause but is not the most common cause.

You prescribe 30 mL lactulose three times daily for a patient with cirrhosis. What is the best way to assess the efficacy of this regimen?

A. Decreased serum bilirubin

B. Decreased serum ammonia

C. Decreased confusion

D. Decreased gynecomastia

Answer: C

Option A: Incorrect. Lactulose does not affect serum bilirubin levels.

Option B: Incorrect. Ammonia levels do not correlate to clinical outcomes in hepatic encephalopathy, but they can be measured to determine if the lactulose is causing ammonia excretion.

Option C: Correct. Efficacy of treatment for hepatic encephalopathy is gauged by assessing the therapeutic effect; in essence, whether the patient is less confused.

Option D: Incorrect. Lactulose does not have an affect on gynecomastia.

Your medical student is treating his first cirrhosis patient and asks you why non-selective β-blockers (NSBB) lower portal hypertension. What is your response?

A. NSBB are extremely potent antihypertensive drugs, so they lower blood pressure throughout the body.

B. NSBB have β1 and β2 blocking properties, so they cause vasodilation in the splanchnic bed, which lowers portal pressure.

C. NSBB act directly on the hepatic vasculature and cause vasodilation.

D. NSBB have β2 blocking properties, which allows for unopposed alpha vasoconstriction in the splanchnic bed.

Answer: D

Option A: Incorrect. NSBB are not extremely potent antihypertensive drugs. They do lower blood pressure throughout the body, but they do not lower splanchnic pressure.

Option B: Incorrect. NSBB ...

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