205: Alcoholism and Hepatitis

Question 1

4 things hepatocytes do

Answer 1

protein synthesis,
bile acid production
xenobiotic metabolism
vitamin D activation

Question 2

what do endothelial cells do?

Answer 2

secret endothelia, prostaglandin, nitric oxide and interlukins

Question 3

what do kupfter cells do?

Answer 3

macrophages

• sit on the endothelium ( sinusoid) - clear endotoxinsy
• act on antigen presenting cells
• secrete cytokines

Question 4

what do stellate cells do?

Answer 4

store Vit A and fat,
produce collagen IV AKA reticulin)
produce hepatic growth factor

Question 5

what type of cells are in the bile duct?

Answer 5

cuboidal and columnar for IgA and IgM production

Question 6

list 6 clinical signs of alcoholic liver disease….

Answer 6

palmar erythema, duprytrons contracture, caput medusae, spider nevi, ascites, jaundice.

Question 7

what is alcoholic steatosis?

Answer 7

fatty infiltrate o he liver secondarry to alcohol use.

Question 8

what is chronic hepatitis?

Answer 8

when the pericentral area become fibrosed. other indications are thickened septa and nodule formations.

Question 9

Name 6 complications of Chronic Liver Disease?

Answer 9

Portal hypertension, spontaneous bacterial peritonitis, acute decompensation ( hepatic encephalopathy/coagulopathy), hepato-renal syndrome, hepatocellular carcinoma.

Question 10

how do you treat alcohol withdrawal?

Answer 10

benzodiazepines - they act in similar way to alcohol and you can tirade the dose down.
Vit B supplement.

Question 11

What is Wernicke’s Encephalopathy?

Answer 11

acute neuro symptoms due to thiamine deficiency. common in alcohol withdrawal.

Question 12

3 symptoms of Wernicke’s Encephalopathy?

Answer 12

Encephalopathy
Occulomotor disturbance
Gait ataxia

Question 13

What is Korsakoff’s syndrome?

Answer 13

irreversible dementia with confabulation due to maxillary body damage.

Question 14

A 750ml bottle of 12% wine has how many units in it?

Answer 14

9 ( 1 unit is 10ml of pure alcohol)

Question 15

A 4% 1/2pint of beer has how many units?

Answer 15

1/2 pint = 284ml 4% of this is 11.36ml ( 1 unit = 10ml of pure alcohol)

Question 16

whats in the portal tract?

Answer 16

a bile duct, a hepatic artery and a portal vein.

Question 17

which cells surround the portal tract?

Answer 17

the peri-portal zone

Question 18

which cells surround the central vein?

Answer 18

the centre-lobular zone

Question 19

what are the ‘limiting plate’?

Answer 19

tightly bound hepatocytes surrounding each portal tract.

Question 20

what is a histological indicator of chronic liver disease?

Answer 20

inflammation and eroding of the limiting plate.

Question 21

the pockets of endothelial cells surrounding the hepatocytes are called?

Answer 21

sinusoids

Question 22

what can be found in the ‘Space of Disse’

Answer 22

reticulin fibres and stellate cells

Question 23

reticulin if made of what?

Answer 23

collagen type III

Question 24

what is haemochromatosis?

Answer 24

gene mutation - trap iron.

Question 25

What are the 2 neuronal targets of alcohol?

Answer 25

Potentiates GABA and reduces MNDA and Calcium channel (glutamate release)

Question 26

decreased response to the effects of alcohol

Answer 26

tolerance

Question 27

the need to have alcohol to avoid withdrawl

Answer 27

dependence

Question 28

continued use of alcohol dispute known adverse consequences

Answer 28

addiction

Question 29

What is the Himmelsbach Hypothesis?

Answer 29

that a neuroadaptation occurs (GABA, glutamate and Ca channels) when there is long tern alcohol exposure - to regain equilibrium. ( drink yourself sober/ tolerance) but then the brain is then dependent on alcohol to maintain that equilibrium. hence withdrawal syndrome.

Question 30

which pathway is activated by drugs of abuse?

Answer 30

the Mesolimbic Dopamine Pathway.

Question 31

where in the brain is dopamine produced?

Answer 31

vental tegmental area and the substantial nirga

Question 32

thinking, judgement and willpower is associated with which part of the brain?

Answer 32

prefrontal cortex

Question 33

dopamine released and has a role in addiction and cravings

Answer 33

nucleus acumbens

Question 34

helps brain to focus on the source of temptation

Answer 34

anterior cingulate

Question 35

seat of basic emotions and learning

Answer 35

limbic brain

Question 36

addictive drugs, food and sex make it pump out dopamine

Answer 36

ventral tegmental area

Question 37

key source of dopamine

Answer 37

substantia nigra

Question 38

alerts brain to temptation

Answer 38

amygdala

Question 39

adenosine receptor antagonist?

Answer 39

caffeine

Question 40

primary effect of ketamine is on which receptor?

Answer 40

NMDA (antagonist)

Question 41

which enzyme is involved in 1st pass metabolism of alcohol?

Answer 41

Alcohol dehydrogenase. (ethnol-acetaldehyde)

Question 42

what does acetaldehyde dehydrogenase do?

Answer 42

converts aldehyde to acetate in the 2nd part of 1st pass metabolism

Question 43

metabolic consequences of alcoholism?

Answer 43

increase release of fatty acids from adipose tissue.
reduced triglicerides from liver
reduced rates of fatty acid oxidation increased rates of lips synthesis
progresses to hepatitis

Question 44

which blood test indicates and inflamed liver?

Answer 44

ALT

Question 45

which liver function test indicates bile duct, bone and placenta activity?

Answer 45

ALP

Question 46

which blood tests indicate liver as well as heart or skeletal muscle?

Answer 46

AST

Question 47

anti-mitochondrial antibodies suggest

Answer 47

primary billiary cirrhosis

Question 48

smooth muscle antibodies suggest

Answer 48

autoimmune hepatitis

Question 49

antinuclear cytoplasmic antibodies suggest

Answer 49

sclerosing cholangitis