# Situation: A 62-year-old woman has cirrhosis caused by chronic hepatitis B. Endoscopy shows large esophageal varices that have never bled. She has moderate ascites and takes spironolactone, furosemide, and lactulose. Carvedilol has just been started. She is scheduled for a liver ultrasound every 6 months even when she feels well. She asks why. Which explanation is accurate?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=630393  
> language: ko  
> subject: Nursing Practice IV — Care of Clients with Problems in Nutrition and Gastrointestinal, Metabolism and Endocrine, Perception and Coordination

## 문제

Situation: A 62-year-old woman has cirrhosis caused by chronic hepatitis B. Endoscopy shows large esophageal varices that have never bled. She has moderate ascites and takes spironolactone, furosemide, and lactulose. Carvedilol has just been started.

She is scheduled for a liver ultrasound every 6 months even when she feels well. She asks why. Which explanation is accurate?

## 보기

1. It measures how much scarring her liver has
2. It finds liver cancer early, while it is treatable **✔ 정답**
3. It checks whether the varices have grown larger
4. It detects fluid in the abdomen before it builds up

**정답: 2**

## 해설

Clients with cirrhosis, and selected carriers of chronic hepatitis B, have ultrasound, with or without alpha-fetoprotein, every 6 months as surveillance for hepatocellular carcinoma, which chronic hepatitis B commonly causes. Finding a small tumor early allows resection, ablation, or transplant. Fibrosis is staged with transient elastography, and varices are checked by endoscopy.

## 심화 해설

The purpose of six-monthly ultrasound
She has cirrhosis caused by chronic hepatitis B, which places her at high risk of hepatocellular carcinoma (HCC). Clients with cirrhosis, and selected carriers of chronic hepatitis B, have ultrasound, with or without alpha-fetoprotein (AFP), every 6 months as surveillance for hepatocellular carcinoma. The accurate explanation is that the scan finds liver cancer early, while it is still treatable. Surveillance continues even when she feels well, because early tumors usually cause no symptoms.

Why early detection matters
HCC develops in livers damaged by chronic inflammation and regeneration. Chronic hepatitis B is a particularly important cause because the virus can promote cancer even before cirrhosis is advanced. A small tumor found on routine surveillance can often be treated with resection, ablation, or liver transplantation, all of which offer a chance of cure. A tumor found only after it causes pain, weight loss, or a palpable mass is usually too advanced for these options. The six-month interval is chosen to catch tumors while they are still small.

Why the other explanations are inaccurate
Measuring the amount of scarring is done with transient elastography, which assesses liver stiffness, not with routine surveillance ultrasound. Checking whether varices have grown is done by endoscopy, which allows varices to be seen directly and graded. Detecting fluid before it builds up is not the purpose here; her ascites is already known and managed clinically with diuretics and paracentesis.

| Question | Test used |
| --- | --- |
| Has liver cancer developed? | Ultrasound every 6 months, with or without AFP |
| How much fibrosis is present? | Transient elastography |
| Are varices present or enlarging? | Upper endoscopy |
| Is there ascites or infected fluid? | Clinical assessment, ultrasound, diagnostic paracentesis |

Nursing application
The nurse explains the purpose of surveillance in plain terms, emphasizes keeping every appointment even when she feels well, and reinforces other measures that reduce cancer risk, such as continuing antiviral treatment if prescribed and avoiding alcohol. The nurse also teaches her to report new abdominal pain, weight loss, or worsening jaundice.

Exam takeaway
Key point In cirrhosis or chronic hepatitis B, ultrasound every 6 months is cancer surveillance. Match each test to its purpose: elastography for fibrosis, endoscopy for varices.

## 임상 시나리오

HCC Surveillance in CirrhosisWhy the ultrasound is repeated every 6 months
Cirrhosis from chronic hepatitis B carries a high risk of hepatocellular carcinoma. Ultrasound every 6 months, with or without alpha-fetoprotein, detects tumors while they are small and treatable.

Early tumors may be treated with resection, ablation, or transplant. Fibrosis is staged with transient elastography, and varices are checked by endoscopy.

CautionSurveillance continues even when the client feels well, because early liver cancer is usually silent.

## 핵심 개념

- **Hepatocellular carcinoma** — Primary liver cancer arising from hepatocytes, commonly in cirrhosis or chronic hepatitis B.
- **Surveillance** — Regular testing of an at-risk person who has no symptoms, to detect disease early.
- **Alpha-fetoprotein** — A serum protein that may rise in hepatocellular carcinoma and is sometimes used with ultrasound.
- **Transient elastography** — An ultrasound-based test that measures liver stiffness to estimate fibrosis.

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