Alcohol & Metabolic Liver Diseases Flashcards
ddx for abnormal AST and ALT (alcohol & metabolic causes)
*alcohol
*metabolic dysfunction-associated steatotic liver disease (MASLD) [formerly, non-alcoholic fatty liver disease]
*hemochromatosis
*Wilson’s disease
*alpha-1 antitrypsin
ddx for abnormal alkaline phopshatase (alcohol & metabolic causes)
*choledocholithiasis
*tumor
imaging for abnormal LFTs
- ULTRASOUND should be the first test
-more sensitive than CT for gallstones
-equally sensitive for dilated ducts
-portable, cheap, no radiation, no IV contrast - CT if the ultrasound is negative
acute alcoholic hepatitis - clinical features
*history: significant alcohol exposure, RUQ pain, fever, jaundice
*PE: fever, RUQ tenderness, hepatomegaly
*labs: AST/ALT > 2:1, AST < 300
*liver biopsy: MALLORY BODIES, steatosis, PMNs, ballooning
LFTs for acute alcoholic hepatitis
AST / ALT > 2:1, AST < 300
mallory bodies
*histology finding indicative of acute alcoholic hepatitis
acute alcoholic hepatitis - treatment
*alcohol abstinence
*nutritional support
*prophylaxis against gastric mucosal bleeding (PPIs)
alcoholic cirrhosis - clinical features
*history: significant alcohol exposure (50 gm EtOH per day x 20-30 years for males; half of that for females)
*exam:
-spider angiomata, palmar erythema
-Dupuytren’s contractures
-parotid enlargement
-gynecomastia
-testicular atrophy
-peripheral neuropathy
*LABS:
-AST/ALT > 2:1
-increased GGT
-increased MCV (large RBCs)
metabolic dysfunction-associated steatotic liver disease (MASLD) - epidemiology
*more common in men & Hispanics
*associated conditions:
-obesity
-diabetes mellitus
-hyperlipidemia (TG and/or cholesterol)
note - this is NON-ALCOHOLIC FATTY LIVER DISEASE
metabolic dysfunction-associated steatotic liver disease (MASLD) - diagnosis
*AST/ALT < 1
*exclude other causes (HBV, HCV, hereditary hemochromatosis)
*liver ultrasound
*liver biopsy good but rarely used
metabolic dysfunction-associated steatotic liver disease (MASLD) - treatment
*diet, exercise, weight loss
*treat associated conditions (DM, hyperlipidemia)
*bariatric surgery
*GLP-1 agonists?
hereditary hemochromatosis - etiology
*autosomal recessive mutation of HFE gene
*caused by reduced hepatic release (or activity) of hepcidin
hereditary hemochromatosis - clinical manifestations
*after age 40 in men, 50 in women
*fatigue, arthropathy, diabetes, impotence, hyperpigmentation, cardiomyopathy
hereditary hemochromatosis - diagnosis
*transferrin saturation > 50%
*ferritin > 200
*genetic testing C282Y/C282Y
hereditary hemochromatosis - treatment
phlebotomy to ferritin < 50