Alcoholic hepatitis + NAFLD

Question 1

What is hazardous drinking?

Answer 1

drinking more than the recommended weekly allowance or in a risky manner

Question 2

What is harmful drinking?

Answer 2

hazardous drinking with health or social problems directly related to alcohol

Question 3

What is dependent drinking?

Answer 3

feel cannot function without alcohol
features include tolerance, withdrawal symptoms, desire and unsuccessful attempts to cut down, use despite knowledge of harm

Question 4

Factors that influence the development of alcoholic liver disease

Answer 4

women at greater risk than men
genetic variability
nutrition
co-infection with hepatitis viruses
co-exposure to drugs/toxins
immunological derangements
development of antibodies to neo-antigens
haemochromatosis
alpha-1-antitrypsin deficiency

Question 5

Clinical presentations of alcoholic liver disease

Answer 5

withdrawal
alcoholic steatosis
alcoholic hepatitis
cirrhosis and its complications

Question 6

Alcohol withdrawal timeline

Answer 6

first 8 hours = anxiety, insomnia, nausea, abdominal pain

1-3 days = high BP, increased body temp.

1 week = hallucinations, fever, seizures, agitation

Question 7

Is alcoholic liver disease reversible?

Answer 7

usually reversible with abstinence

Question 8

What is NAFLD a phenotype of?

Answer 8

metabolic syndrome

Question 9

How is NAFLD diagnosed?

Answer 9

usually normal LFTs
normal incidental finding on US

Question 10

What AST:ALT ratio excludes fibrosis?

Answer 10

<0.8

Question 11

What is fibroscan and when can it be used?

Answer 11

uses pulsed US to produce a shear wave
can differentiate moderate fibrosis in a variety of liver diseases including NAFLD - can also stage disease

Question 12

What is the gold standard test for diagnosing and staging NAFLD?

Answer 12

liver biopsy
invasive - not done on everyone

Question 13

NASH microscopic changes

Answer 13

fatty change
ballooned hepatocytes
Mallory’s hyaline and neutrophilic infiltrate

Question 14

Which liver disease is nuclear vacuolation common in?

Answer 14

more common in NAFLD than alcoholic liver disease

Question 15

Unusual causes of NAFLD

Answer 15

disorders of lipid metabolism
TPN
Hep C infection
severe surgical weight loss
medications - amiodarone, tamoxifen, methotrexate, steroids, HAART
starvation
Wilson’s disease
coeliac disease
growth hormone deficiency

Question 16

Management of NAFLD

Answer 16

lifestyle modification - weight loss, exercise

targeting components of metabolic syndrome - DM management, HTN management, lipid optimisation, OSA management

liver-directed pharmacotherapy - bariatric surgery, pioglitazone

managing complications of cirrhosis - varices surveillance, HCC surveillance, osteoporosis management, liver transplantation