Alcoholic Liver Flashcards
Alcohol dependence rates
about 7.4% of americans at some point
Alcoholic liver disease makes up what percent of chronic liver disease
24%
Chronic liver disease …most common cause
Hep C
The stages of Alcoholic Liver disease are:
1) Steatosis
2) Alcoholic hepatitis
3) Alcoholic Cirrhosis
- hepatocellular carcinoma
What is ethanol abuse
40-80 gm/day for more than 5 years duration….12 oz beer = 12 gm
About 5 drinks a day in men
3 drinks a day in women = alcoholism
ok
What accounts for the difference in men and women?
- differences in volume of distribution (weight and size)
- Decreased gastric alcohol dehydrogenase activity, particularly in younger adults
- Differences in first pass metabolism
Clinical findings of alcoholic hepatitis
Fever, muscle wasting, ascites
Hepatomegaly (due to fat content in liver) with tenderness on palpatation
AST more than 2x ALT
AST and ALT rarely over….
300….if you see AST and ALT over 300, think somehting else. Alcohol may be involved but their is another factor somewhere
What polymorphism in East Asians is related to increased susceptibility ot ALD?
ADH2*1
TNF Alpha-238?
potential polymorphis that predisposes to ALD in caucasians
Mechanism of LIver injury
Acetylaldehyde from the Ethanol causes intestinal injury which leads to increased permeability resulting in Endotoxemia Toxins in the blood)
- Endotoxemia then results in an inflammatory response from Kupffer cells (liver macrophages that clean up toxins in the blood) and cytokine release that is problematic
Two Hit theory
1st hit= Fatty liver
- oxidative stress along with obesity and DM sensitizes liver to second hit
2nd hit= The inflammation and necrosis
Magic number for Maddrey score
32….over 32 means poor prognosis, under means it could be worse
Glasgow score magic numbner
9…..under ok, over terrible
