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HPIM Gastro > 363: Alcoholic Liver Disease > Flashcards

363: Alcoholic Liver Disease Flashcards

1
Q

Pathology of alcoholic liver disease consists of 3 major lesions

A
  1. Fatty liver (present in 90% of daily and binge drinkers)
  2. Alcoholic hepatitis
  3. Cirrhosis
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2
Q

T or F: Alcohol is an indirect hepatotoxin.

A

False.

Direct hepatotoxin

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3
Q

World’s 3rd largest risk factor for disease burden

A

Alcohol

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4
Q

Most important risk factors in development of alcoholic liver disease

A

QUANTITY and DURATION of alcohol intake

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5
Q

Strong determinant for alcoholic liver disease

A

Gender

Women>Men

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6
Q

T or F: Time it takes to develop liver disease IS DIRECTLY RELATED to the amount of alcohol consumed

A

True

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7
Q

Equivalent of 12g of alcohol

A
  1. One beer
  2. Four ounces of wine
  3. One ounce of 80% spirits
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8
Q

Factors for gender-dependent differences in development of alcoholic liver disease

A
  1. Effects of estrogen
  2. Proportion of body fat
  3. Gastric metabolism of alcohol
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9
Q

Important comorbidity in progression of alcoholic liver disease to cirrhosis in chronic and excessive drinkers

A

Chronic Hepatitis C infection

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10
Q

Risk factor for alcoholic liver disease:

QUANTITY and GENDER

A

QUANTITY:
Men: 40-80g/d of etOH produces fatty liver; 160g/d for 10-20 yrs cause hepatitis or cirrhosis; 15% develop ALD

Gender: Women with increased susceptibility at amounts >20g/d; two drinks per day is probably safe

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11
Q

Risk factor for alcoholic liver disease:

HEPATITIS C, GENETICS, FATTY LIVER

A

Hepa C: HCV with ALD associated with younger age for severity, more advanced histology, decreased survival

Genetics: Patatin-like phospholipase domain-containing protein 3 (PNPLA3) associated with alcoholic cirrhosis

Fatty liver: Obesity and nonalcoholic fatty liver are risk factors. Emphasis on nutritional support

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12
Q

Intestinal derived endotoxins that initiates pathogenic process that facilitates hepatocyte apoptosis and necrosis

A

Toll-like receptor 4

Tumor necrosis factor alpha (TNF-a)

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13
Q

Initial and most common histologic response to hepatotoxic stimuli, including excessive alcohol ingestion

A

Fatty liver

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14
Q

Major enzyme responsible for alcohol metabolism

A

Alcohol dehydrogenase

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15
Q

T or F: Cessation of drinking results in normalization of hepatic architecture and fat content in ALD (Reversible)

A

True

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16
Q

Hallmark of alcoholic hepatitis

A

Hepatocyte injury

Ballooning degeneration, spotty necrosis, polymorphonuclear infiltrate, fibrosis of perivenular and perisinusoidal space of Disse

17
Q

T or F: Portal hypertension, ascites and variceal bleeding can occur in the absence of cirrhosis.

A

True

18
Q

Laboratory features of alcoholic liver disease

A
  1. Elevated AST, ALT two to sevenfold. Rarely >400IU, and AST/ALT is >1
  2. Hyperbilirubinemia
  3. Modest increase in alkaline phosphatase level
19
Q

Short-term (30-day) mortality rates is observed in what percentatge of critically ill patients with alcoholic hepatitis

A

> 50%

20
Q

Features of severe alcoholic hepatitis

A
  1. Coagulopathy (Prothrombin time increased >5s)
  2. Anemia
  3. Serum albumin concentration <25g/L (2..5mg/dL)
  4. Serum bilirubin levels >137 umol/L (8 mg/dL)
  5. Renal failure
  6. Ascites
21
Q

MELD score that is associated with significant mortality in alcoholic hepatitis

A

> /= 21

22
Q

Cornerstone of treatment of alcoholic liver disease

A

Complete abstinence from alcohol

23
Q

T or F: Referral of patients to experienced alcohol counselors and/or alcohol treatment programs should be routine in management of alcoholic liver disease

A

True

24
Q

Severe alcoholic hepatitis in discriminant function and MELD

A

Discriminant function >32

MELD >20

25
Q

Preferred treatment for severe alcoholic hepatitis

A

Prednisone 40 mg/d OR
Prednisolone 32 mg/d
For 4 weeks followed by steroid taper

Exclusion: Active GI bleeding, renal failure, pancreatitis

*Women are good candidates

26
Q

Scoring system that uses pretreatment variables plus the change in total bilirubin at day 7 of glucocorticoids to identify patients unresponsive to therapy

A

Lille score >0.45

27
Q

A nonspecific TNF inhibitor that demonstrated improved survival in the therapy of severe alcoholic hepatitis, primarily due to decrease in hepatorenal syndrome; Alternative treatment

A

Pentoxifylline 400mg PO TID x 4 weeks

28
Q

An accepted indication for treatment in selected and motivated patients with end-stage cirrhosis

A

Liver transplantation

HPIM Gastro (7 decks)

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