Cirrhosis: The Daily PANCE Blueprint
Which of the following lab abnormalities would you most likely expect in a patient with cirrhosis?
A. Hyponatremia, elevated INR, thrombocytopenia, hypoalbuminemia
B. Hypernatremia, elevated INR, thrombocytosis, hyperalbuminemia
C. Elevated PTT and INR, pancytopenia, elevated d-dimer, low Vitamin K
D. Elevated PTT and INR, leukocytosis, high Vitamin K, low lactate
E. None of the above
Answer and topic summary
The answer is A. Hyponatremia, elevated INR, thrombocytopenia, hypoalbuminemia
Cirrhosis is a horrible chronic disease with inflammation, necrosis, fibrosis, hepatocellular dysfunction, and vascular remodeling potentially leading to liver failure +/- cancer. The most common causes of cirrhosis are hepatitis C and alcohol abuse. Symptoms cirrhotic patients may have include fatigue, anorexia, weight loss, & easy bruising. On physical exam, you may appreciate spider angiomas, jaundice, palmar erythema, or hepatomegaly. A liver biopsy gives a definitive diagnosis but is rarely performed. It’s important to recognize the lab issues that cirrhosis may cause — it can lead to hyponatremia (due to expanded extracellular fluid volume and plasma volume with ascites and edema), elevated INR (decreased synthetic function of the liver), thrombocytopenia (due to decreased thrombopoietin production + splenic sequestration), hypoalbuminemia (again, loss of synthetic function of the liver), and elevated lactate (since lactate is cleared by the liver).
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Smarty PANCE Content Blueprint Review:
Covered under ⇒ PANCE Blueprint GI and Nutrition ⇒ ⇒
Also covered as part of the Internal Medicine, Family Medicine, and Emergency Medicine PAEA EOR topic list
