Alcohol and the Liver

Question 1

4 main consequences of metabolism of alcohol

Answer 1

Acetaldehyde Production
Acetate Production
Increased NADH/NAD ratio
Non-Oxidative Metabolism

Question 2

Acetaldehyde Production

Answer 2

– Binds to proteins and DNA: immunogenic

– Stimulates collagen production by Stellate cells

Question 3

Acetate Production

Answer 3

– Increased acetyl co-A promotes inflammation by histone acetylation

Question 4

Increased NADH/NAD ratio

Answer 4

– Increased fatty acid synthesis; reduced fatty acid

oxidation: promotes steatosis

Question 5

Non-Oxidative Metabolism

Answer 5

– Fatty acid ethyl ester production: promotes steatosis

Question 6

2 main pathways of apoptosis in ALD

Answer 6

intrinsic and extrinsic

Question 7

Intrinsic pathway

Answer 7

Initiated by Oxidative Stress
Leads to leakage of pro- apoptotic factors from mitochondria (ie cytochrome-c), regulated by Bcl-2 proteins
Pro-apoptotic factors from mitochondria activate Caspases leading to cell degradation

Question 8

Extrinsic pathway

Answer 8

Initiated by TNF
Binding to TNF receptors leads to Caspase activation via FADD (Fas-associated death domain) and TRADD (TNF Receptor-associated death domain) proteins

Question 9

Fatty liver histology

Answer 9

Predominantly Macrosteatosis in Zone 2 and 3.

Question 10

Alcoholic hepatitis histology

Answer 10

Classically Micronodular, with or without evidence of alcoholic hepatitis

Question 11

Alcoholic cirrhosis histology

Answer 11

Classically Micronodular, with or without evidence of alcoholic hepatitis