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Q1: Definition (2 min)
"What is cirrhosis?"
- Diffuse hepatic fibrosis with regenerative nodule formation disrupting architecture and vascular physiology
- Leads to portal hypertension and synthetic/detoxification failure
- Compensated vs decompensated (ascites, variceal bleed, encephalopathy, jaundice)
Q2: Child-Pugh and MELD (3 min)
"Reproduce Child-Pugh components. What is MELD used for?"
- Child-Pugh: bilirubin, albumin, INR, ascites, encephalopathy → A/B/C
- MELD(Na): bilirubin, INR, creatinine (± sodium) — transplant allocation and short-term mortality
- Higher scores → worse survival
Q3: Ascites and SBP (2 min)
"How do you diagnose SBP?"
- Diagnostic paracentesis
- Ascitic PMN ≥250/mm³ → treat empirically
- Culture in blood culture bottles; SAAG interprets portal hypertension
Q4: Variceal primary prophylaxis (2 min)
"Who gets a non-selective beta-blocker?"
- Patients with medium/large varices or red signs, or decompensated cirrhosis with varices — carvedilol/propranolol/nadolol per protocol
- Alternative endoscopic banding if intolerant
- Screen with endoscopy (or non-invasive risk tools in selected compensated patients)
Q5: Hepatic encephalopathy (2 min)
"First-line therapy for overt HE?"
- Identify precipitant (GI bleed, infection, electrolytes, drugs, constipation)
- Lactulose titrated to 2–3 soft stools/day
- Add rifaximin for recurrent HE
- Airway protection if deep coma