9. Alcoholic Liver Disease

Question 1

What CYP enzyme is responsible for EtOH metabolism?

Answer 1

CYP2E1

Question 2

What are the 2 alcohol metabolizing enzymes?

Answer 2

Alcohol Dehydrogenase (ADH)
Aldehyde Dehydrogenase (ALDH)

Question 3

The liver converts ________ and _________ into _________ and ________.

Answer 3

carbohydrates
proteins
fatty acids
triglycerides

Question 4

The liver _________ triglycerides to produce energy.

Answer 4

oxidizes

Question 5

The liver is responsible for synthesizing what lipids?

Answer 5

plasma lipoproteins
cholesterol
phospholipids

Question 6

What plasma proteins does the liver synthesize?

Answer 6

albumin and clotting factors

Question 7

A (high/low) INR means the patient is at risk for uncontrolled bleeding.

Answer 7

high

Question 8

Ethanol is metabolized to acetaldehyde by what enzyme?

Answer 8

ADH

Question 9

ADH converts ______ to _________.

Answer 9

ethanol to acetaldehyde

Question 10

Acetaldehyde is metabolized to acetate by what enzyme?

Answer 10

ALDH

Question 11

ALDH converts ________ to ________.

Answer 11

acetaldehyde to acetate

Question 12

Pale palms are a sign of alcoholic liver disease. (T/F)

Answer 12

False, red palms are a sign of alcoholic liver disease.

Question 13

In men, what amount of alcohol consumption can cause alcoholic liver disease?

Answer 13

10 years of > 60-80 g/day

Question 14

In women, what amount of alcohol consumption can cause alcoholic liver disease?

Answer 14

10 years of >20 g/day

Question 15

What are the 3 stages of alcoholic liver disease?

Answer 15

• Alcoholic fatty liver disease
• Alcoholic hepatitis
• Cirrhosis

Question 16

Name 3 presentations of Alcoholic fatty liver.

Answer 16

• anorexia
• fatigue
• RUQ discomfort
• hepatomegaly
• AST and GGT elevation

Question 17

Name 3 presentations of Alcoholic Hepatitis.

Answer 17

• severe malaise
• fever
• protein/calorie malnutrition
• jaundice
• coagulopathy
• ascites
• encephalopathy
• elevated AST and GGT
• decreased serum albumin

Question 18

What is the most effective treatment for alcoholic hepatitis?

Answer 18

abstaining from alcohol

Question 19

Under what criteria would you recommend Prednisolone for alcoholic hepatitis?

Answer 19

Maddrey’s Discriminant Function > 32

Model for end-stage liver disease > 21

Question 20

What 3 medications can be used to treat alcoholic hepatitis?

Answer 20

• Prednisolone
• Pentoxifylline
• N-AcetylCysteine

Question 21

In what cases would N-AcetylCysteine be recommended?

Answer 21

short term mortality benefit

Question 22

Which is a clinical manifestation of chronic alcoholism?

a. pale palms of hands
b. enlarged testicles
c. gynecomastia
d. shrunken sinus cavities

Answer 22

c. gynecomastia

Question 23

Which of the following is NOT a stage of alcoholic liver disease?

a. alcoholic fatty liver
b. alcoholic poisoning
c. alcoholic hepatitis
d. cirrhosis

Answer 23

b. alcoholic poisoning

Question 24

The primary treatment for alcoholic liver disease is?

a. abstaining for alcohol
b. prednisone
c. rifaxamin
d. acetaminophen

Answer 24

a. abstaining for alcohol

Question 25

Which medication was show in an NEJM study to have a benefit in short term mortality?

a. ibuprofen
b. rifaxamin
c. N-acetylcysteine
d. ethanol

Answer 25

c. N-acetylcysteine

Question 26

Which of the following is NOT a clinical manifestation of alcoholic hepatitis?

a. encephalopathy
b. coagulopathy
c. ascites
d. elevated serum albumin

Answer 26

d. elevated serum albumin