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People and Illness > Alcohol and The Liver > Flashcards

Alcohol and The Liver Flashcards

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1
Q

What is meant by a unit of alcohol in the UK?

A

8g or 10ml of alcohol

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2
Q

At what age does alcoholic liver disease peak within the population?

A

Approximately 50 years old

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3
Q

The amount, type and frequency of alcohol consumption affect the likelihood of alcoholic liver disease developing. T/F?

A

True

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4
Q

The majority of heavy alcohol abusers will develop steatosis. T/F?

A

True

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5
Q

Cirrhosis is reversible. T/F?

A

False

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6
Q

Hepatitis is reversible. T/F?

A

True

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7
Q

Most alcoholics will develop cirrhosis. T/F?

A

False - only about 10-20% will

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8
Q

Which enzyme in the liver is mostly responsible for converted alcohol to acetaldehyde?

A

Alcohol dehydrogenase

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9
Q

Which liver enzyme is responsible for conversion of acetaldehyde to acetate in the metabolism of alcohol?

A

Acetaldehyde dehydrogenase

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10
Q

The initial conversion of alcohol to acetaldehyde occurs in which part of the cell in alcohol metabolism?

A

Cytosol

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11
Q

The conversion of acetaldehyde to acetate occurs in which part of the cell in alcohol metabolism

A

Mitochondria

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12
Q

Which enzyme is involved in the microsomal ethanol oxidising system?

A

Cytochrome p450 2E1

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13
Q

Which alcohol metabolism pathways result in the production of reactive oxidative species?

A

Microsomal ethanol oxidising system

catalase

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14
Q

What is the main pathway for the metabolism of alcohol?

A

Alcohol dehydrogenase pathway

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15
Q

When the main pathway for the metabolism of alcohol because saturated in alcohol excess, which pathways are induced?

A

Catalase pathway

Micorosmal ethanol oxidising system pathway

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16
Q

Acetaldehyde from alcohol metabolism binds to DNA. What effects does this have?

A

Immunogeneic

Stimulates collagen production

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17
Q

Acetate from alcohol metabolism results in increased acetyl coA concentrations. How does this promote inflammation?

A

By histone acetylation

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18
Q

Alcohol metabolism results in an increased NADH:NAD ratio. What effects does this have?

A

Increased fatty acid synthesis
reduced fatty acid oxidation
promotes steatosis

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19
Q

Alcohol metabolism results in the production of hydrogen peroxide and superoxide ions. How does this lead to increased TNF-alpha production?

A

Activates redox sensitive transcription factors such as NF-kappaB

20
Q

What is the result of the increased TNF-alpha levels in alcohol metabolism?

A

promotion of lipid per oxidation
promotion of inflammation
damage of mitochondrial membranes causing apoptosis
activates stellate cells to produce collagen causing fibrosis
increased intestinal permeability

21
Q

Alcohol consumption results in increased intestinal permeability. How does this lead to the production of TNF-alpha?

A

Bacterial products such as endotoxins leak out of the intestines
this promotes activation of kupffer cells which promote liver injury and produce TNF-alpha

22
Q

Which cytokine is produced as a result of increased ROS in alcohol metabolism, causing recruitment of neutrophils?

A

IL-8

23
Q

How does oxidative stress in alcohol metabolism cause apoptosis of liver cells?

A

Leads to leakage of pro-apoptotic factors from the mitochondria regulated by Bcl-2 proteins. pro-apoptotic factors activate caspases leading to cell degradation

24
Q

In alcoholic liver disease, how is the extrinsic apoptotic pathway initiated?

A

By TNF-alpha

25
Q

How does TNF-alpha activated the extrinsic apoptotic pathway in alcohol metabolism?

A

Causes caspase activation via fas-associated death domain

26
Q

What is the name of the vesicles containing broken down cell components from apoptosis?

A

Apoptotic bodies

27
Q

How does apoptosis differ from necrosis?

A

Natural cell death
Stimulated by cell signals
Can be beneficial
Produces cell fragments which can send signals that facilitate phagocytosis

28
Q

depletion of trace elements may exacerbate ROS production and promote apoptosis in alcohol metabolism. T/F?

A

True

29
Q

From what is glutathione synthesised?

A

Methionine

30
Q

Glutathione synthesis from methionine is reduced by a deficiency in…?

A

Folate

Vitamin B6

31
Q

When there is disrupted methionine metabolism there is reduced conversion of s-adenosylmethionine to s-adenosylhomocysteine. What are the results of this?

A

Reduced trans methylation and impaired gene expression
Increased caspase expression causing apoptosis
Increased TNF-alpha production causing inflammation
Reduced cystathionine beta sythase activity

32
Q

Obesity induces the enzyme involved in the microsomal ethanol oxidising system. T/F?

A

True

33
Q

Why is AST always higher than ALT in alcoholic liver disease?

A

AST is a mitochondrial enzyme, ALT is a cytosolic enzyme
In alcoholic liver disease, the mitochondria is broken down in apoptosis and there are therefore very high levels of AST in the blood

34
Q

Alcohol induces lipodystrophy. T/F?

A

True

35
Q

In which zones of the hepatic acini does steatosis usually occur predominantly?

A

Zone 2 and 3

36
Q

What are the hallmarks of alcoholic hepatitis as seen on a histological sample?

A 
Swollen heptocytes
Giant mitochondria
Steatosis
Mallory bodies
Collagen
37
Q

What non-invasive technique can be used to measure the stiffness of the liver?

A

Transient elastography

38
Q

What are the non-specific symptoms of alcoholic liver disease?

A

Malaise, nausea

39
Q

What are the signs and symptoms of alcoholic liver disease?

A

Malaise, nausea, fever, jaundice, hepatomegaly, sepsis, encephalopathy, ascites, renal failure, death

40
Q

The Glasgow alcoholic hepatitis score can indicate the severity of hepatitis. What factors are assessed in this scale?

A 
Age
White blood cell count
Urea
Prothrombin time
Bilirubin
41
Q

How can patients with a high Glasgow alcoholic hepatitis score be treated?

A

High dose steroid - prednisolone

ntiinflammatory

42
Q

How much fluid needs to be present in ascites to be detectable by percussion?

A

5-6L

43
Q

How much fluid needs to be present in ascites to cause the patient to have a tense, uncomfortable abdomen?

A

12L

44
Q

What are the stigmata of liver disease?

A 
Spider nave
encephalopathy 
prolonged prothrombin time
palmar erythema
hypoalbuminaemia
45
Q

What are the signs of portal hypertension?

A

Caput medusae
hypersplenism
thrombocytopenia

46
Q

The Childs-Pugh score can indicate the severity of chronic liver disease. What factors are assessed in this score?

A 
Encephalopathy
ascites
bilirubin
albumin
prothrombin time
47
Q

Alcoholic cirrhosis is often found incidentally. T/F?

A

True

People and Illness (18 decks)

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