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IM > Alcoholic Liver Disease > Flashcards

Alcoholic Liver Disease Flashcards

1
Q

Most important risk factors involved in the devt of alcoholic liver disease

A

QUANTITY and DURATION of alcohol intake

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2
Q

MEN - quantity of ethanol that produces FATTY LIVER

A

40-80 g/day

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3
Q

MEN - quantity of ethanol that produces HEPATITIS or CIRRHOSIS for 10-20 yrs

A

160 g/day

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4
Q

Exhibit increased susceptibility to alcohol liver disease at amt > 20 g/day

A

WOMEN

safe - 2 drinks per day

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5
Q

Infection concurrent w/ alcoholic liver disease associated w/ younger age for severity, more advanced histology and decreased survival

A

Hepatitis C

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6
Q

Gene associated with ALCOHOLIC CIRRHOSIS

A

Patatin like phospholipase domain containing protein 3 (PNPLA3)

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7
Q

Important comorbidity in the progression of alcoholic liver disease to cirrhosis in chronic drinker

A

Chronic Infection with Hepatitis C virus

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8
Q

The Initial and MC histologic response to hepatotoxic stimuli

A

FATTY LIVER

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9
Q

Hallmark of Alcoholic Hepatitis

A

HEPATOCYTE INJURY

ballooning degeneration
spotty necrosis
polymorphonuclear infiltrate
fibrosis - perivenular and perisinusoidal space of Disse

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10
Q

Precursor to the devt of cirrhosis

A

ALCOHOLIC HEPATITIS

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11
Q

Often the only clinical finding in FATTY LIVER

A

HEPATOMEGALY

RUQ pain
nausea
jaundice (rare)

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12
Q

Clinical Manifestations Alcoholic Hepatitis

A

fever
spider nevi
jaundice
abdominal pain

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13
Q

Alcoholic cirrhosis clinical features

A 
RUQ pain
fever
nausea and vomiting
diarrhea
anorexia
malaise

MORE SPECIFIC COMPLICATIONS
ascites
edema
upper GI hemorrhage

PALMAR ERYTHEMA
SPIDER ANGIOMAS
DUPUYTREN CONTRACTURES
DECREASED BODY HAIR
TESTICULAR ATROPHY
GYNECOMASTIA
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14
Q

AST (SGOT)

A

INC 2 to 7 fold, < 400 IU/L, GREATER than ALT

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15
Q

ALT (SGPT)

A

INC 2 to 7fold, < 400 IU/L

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16
Q

AST/ALT ratio

A

> 1

17
Q

Common laboratory findings in ADVANCED LIVER INJURY

A

Hypoalbuminemia

Coagulopathy

18
Q

Useful in detecting FATTY INFILTRATION of the liver and determining liver size

A

Ultrasonography

19
Q

Heralds SEVERE ALCOHOLIC HEPATITIS

A 
coagulopathy (PT > 5 s)
anemia
serum albumin < 25 g/L
serum bilirubin > 137 mmol
renal failure
ascites
20
Q

MELD score associated with significant mortality in alcoholic hepatitis

A

Model for End Stage Liver Disease (MELD > 21)

21
Q

The cornerstone in the treatment of alcoholic liver disease

A

Complete abstinence from alcohol

22
Q

FDA approved medications for alcohol dependence

A

Disulfiram
Acamprosate
Naltrexone

23
Q

Glucocorticoids - extensively evaluated in the treatment of alcoholic hepatitis

A

PREDNISONE - 40 mg / day
PREDNISOLONE - 32 mg/ day

4 weeks followed by a steroid taper

24
Q

Glucocorticoids - extensively evaluated in the treatment of alcoholic hepatitis

A

PREDNISONE - 40 mg / day
PREDNISOLONE - 32 mg/ day

4 weeks followed by a steroid taper

25
Q

Nonspecific TNF inhibitor - for SEVERE alcoholic hepatitis

A

Pentoxifylline

26
Q

Accepted indication for treatment in select patients with complications of cirrhosis secondary to alcohol abuse

A

Liver Transplantation

27
Q

Can occur as a consequence of the overlapping injurious processes secondary to alcohol and HCV infection

A

Increased liver iron stores

Porphyria Cutanea Tarda

28
Q

Secondary to effects on sterol regulatory transcription factor and peroxisome proliferator activated receptor a (PPAR- a)

A

steatosis from lipogenesis
fatty acid synthesis
depression of FA oxidation

29
Q

Intestinal derived endotoxin initiates a pathogenic process through

A

toll like receptor 4
tumor necrosis factor a (TNF a)
– facilitates hepatocyte apoptosis and necrosis

30
Q

Activate INNATE and ADAPTIVE immunity pathways releasing proinflammatory cytokines ( TNF a), chemokines, and proliferation of T and B cells

A

Ethanol and its metabolites

31
Q

Pathologic features that may be associated with progressive liver injury

A

giant mitochondria
perivenular fibrosis
macrovesicular fat

32
Q

Often present in florid cases but are NEITHER SPECIFIC NOR NECESSARY to establish the diagnosis

A

Mallory Denk Bodies

33
Q

PRECURSOR to the devt of CIRRHOSIS

A

Alcoholic hepatitis

34
Q

Present in up to 50% of patients with biopsy proven alcoholic hepatitis

A

Cirrhosis

35
Q

Typical lab abnormalities (nonspecific) seen in FATTY LIVER

A

modest elevations of AST, ALT and gamma glutamyl transpeptidase (GGTP)
hypertriglyceridemia
hyperbilirubinemia

36
Q

Findings that indicate SERIOUS LIVER INJURY with LESS POTENTIAL for complete reversal

A

ultrasound of portal vein flow reversal
ascites
intraabdominal venous collaterals

37
Q

Severe alcoholic hepatitis defined as

A

discriminant function > 32

MELD > 20

38
Q

EXCLUSION CRITERIA

A

active GI bleeding
renal failure
pancreatitis

39
Q

Uses pretreatment variables plus the change in total bilirubin at day 7 of glucocorticoids to identify those patients unresponsive to therapy

A

LILLE SCORE > 0.45

IM (66 decks)

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