Alcoholic and fatty liver disease

Question 1

Describe findings that may be seen on a liver biopsy in alcoholic liver disease

Answer 1

fatty liver
hepatitis
cirrhosis

Question 2

What is NAFLD?

Answer 2

macrosteatosis in >5% hepatocytes in the absence of ETOH use

(corollary is alcoholic fatty liver)

Question 3

What is NASH?

Answer 3

macrosteatosis, hepatocellular ballooning, lobular inflammation, often with perisinusoidal fibrosis in the absence of ETOH use

(corollary is alcoholic steatohepatitis)

Question 4

What is cryptogenic cirrhosis

Answer 4

liver is not fatty so etiology is hard to identify

Question 5

________ is the second leading cause of indication for liver transplantation

Answer 5

alcoholic liver disease

first is HCV, declining with better treatment

Question 6

List factors associated with development of alcoholic liver disease

Answer 6

dose of EtOH
gender (women at higher risk of disease with the same dose of alcohol)
Co-morbid HBV, HCV, hemochromatosis, a1 antitrypsin deficiency
Inherited propensity- PNPLA3

Question 7

Alcoholic and non-alcoholic liver disease appear to share a common genetic cause:

Answer 7

PNPLA3- fatty liver deposition and fibrosis, both alcohol mediated and non-alcoholic liver damage

Question 8

What is the link between alcohol use, the gut microbiome, and ALD/NAFLD?

Answer 8

Gut microbiome appears to influence obesity
Chronic ethanol leads to leaky gut, increased translocation of bacterial products, induction of cytokines, oxidative stress

Question 9

What screening questions can be used to assess for high risk drinking?

Answer 9

Cutdown,
Anger,
Guilt,
Eye-openers

If yes to 2+ need to follow up with more questions

Question 10

What factors increase the likelihood of alcoholic relapse?

Answer 10

Social isolation
lack of insight into addiction
history of many failed attempts at rehabilitation
Psychiatric co-morbidities

Question 11

Vitamin ____ improves some aspects of liver histology in NAFLD/NASH

Answer 11

E

Question 12

_________ is the key change in treating NAFLD/NASH

Answer 12

weight loss

impacts Type II DM, obstructive sleep apnea, HTN

Question 13

Weight loss from bariatric surgery improves steatosis, but its effect on _________ is uncertain

Answer 13

liver fibrosis

Question 14

Alcoholic liver disease is a consequence of the effect of alcohol on the gut microbiome interacting with the _______ immune system

Answer 14

innate