Q:

Which of the following statement(s) is/are true concerning the natural history and clinical features of alcoholic cirrhosis?

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Which of the following statement(s) is/are true concerning the natural history and clinical features of alcoholic cirrhosis?


  1. In patients with compensated cirrhosis, the probability of survival at 10 years approaches 50%
  2. The development of clinical evidence of hepatic decompensation reduces five year survival to less than 20%
  3. Continued consumption of alcohol worsens prognosis
  4. The risk of death after variceal hemorrhage depends more on the severity of underlying liver disease than the type of therapy

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a. In patients with compensated cirrhosis, the probability of survival at 10 years approaches 50%

b. The development of clinical evidence of hepatic decompensation reduces five year survival to less than 20%

c. Continued consumption of alcohol worsens prognosis

d. The risk of death after variceal hemorrhage depends more on the severity of underlying liver disease than the type of therapy

Recent studies have analyzed the natural history of cirrhosis as a function of the degree of hepatic decompensation at the time of diagnosis. A high proportion of patients with compensated cirrhosis remain well for many years after diagnosis. In these studies the probability of remaining compensated 10 years after diagnosis was 42%, and survival probability of compensated patients was 47%. The prognosis worsened considerably once patients developed clinical evidence of hepatic decompensation (ascites, jaundice, encephalopathy, or gastrointestinal hemorrhage). Among these patients, the probability of five-year survival was only 16%. The risk of death from variceal hemorrhage depends much more of the severity of the underlying liver disease than on the type of therapy. It would also appear from natural history studies that continued alcohol consumption does affect survival. In one study, the overall five-year survival is 63% for abstainers versus 40.5% for those who continued to drink. Continued alcohol consumption may have less of an effect on survival than the intensity of alcohol consumption. Furthermore, the degree of hepatic compensation at the time of inclusion into the study may have also been an important factor.

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