Week 1 GI-GU
Emergencies Q&A &
Rationales
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Updated 2026 Questions and Answers
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, Hepatorenal syndrome (HRS) functional form of renal failure that occurs primarily in pt with cirrhosis and ascites.
Type 1 hepatorenal syndrome is characterized by... -rapidly progressive renal impairment
-doubling of initial serum Cr to greater than 2.5mg/dL over a period less than 2
weeks
-without liver transplant prognosis is very poor
Type 2 hepatorenal syndrome is characterized by... -moderate form of renal failure
-serum Cr levels between 1.5 to 2.5 mg/dL
reduction in GFR with elevation in serum creatinine
-associated with a more indolent course and improved survival compared to type 1
Risk Factors of hepatorenal syndrome Dilutional hyponatremia
Previous episodes of ascites
Presence of esophageal varices
Poor nutritional status
Infections such as spontaneous bacterial peritonitis
Severe urinary sodium retention (urine sodium < 5 milliequivalents/liter [mEq/L])
Large-volume paracentesis without albumin replacement
Acute alcoholic hepatitis
Low mean arterial blood pressure (map <80 mm Hg)
subjective clinical presentation of hepatorenal syndrome Most clients with HRS have a known diagnosis of acute or chronic liver disease and
present with nonspecific symptoms including:
-dysgeusia (altered taste perception)
-malaise
-fatigue
-decreased urine output.
objective clinical presentation of hepatorenal syndrome HRS has no characteristic physical exam findings.
It is important to assess the client for stigmata of chronic liver disease including:
-spider nevi
-scleral icterus
-lower extremity edema
-asterixis
-abdominal distention
-fluid wave
-paraumbilical hernia
-bruits.
Dx criteria in hepatorenal syndrome 1. cirrhosis with ascites
2. increase in Cr >0.3 mg/dL within 48 hrs or >50% increase from baseline within a
7 day period
3.no response to a 2 consecutive day diuretic withdrawal and volume expansion w/
albumin 1g/kg body wt
4. absence of shock
5. no nephrotoxic drug use
6. no macroscopic signs of structural kidney injury (proteinuria >500
milligrams/deciliter[(mg/dL], microhematuria with >50 red blood cells per high-power
field, and/or abnormal renal ultrasonography)
What is the Creatinine criteria when diagnosing increase in serum creatinine of
hepatorenal syndrome -greater than or equal to 0.3 mg/dL
or
-greater than or equal to 50% increase from baseline Cr
this is within a 7 day period.
What surgical intervention is used to treat hepatorenal TIPS Procedure
syndrome?