Alcoholic Liver Disease Flashcards
which race has the highest death rate of alcoholic cirrhosis
hispanics
most important modifiable risk factor in alcoholic liver injury
Hep C
describe pathways of ethanol breakdown
- oxidative metabolism
- CYP450
mainly in liver, some ADH isoenzymes in stomach
pathogenesis of alcoholic liver disease
centrilobular hypoxia: zone of hypoxia around central veins due to decreased oxygen delivery to central veins (ethanol metabolism consumes O2)
neutrophil infiltration –> release of reactive oxygen species –> proinflammatory and pro-fibrinogenic
acetylaldehyne –> stimulate hepatic collagen synthesis in pericentral zone
cytokines (TNF and IL-6) –> necrosis and inflammation
risk factors for alcoholic liver disease
- amount and duration of ethanol
- viral hepatitis
- genetic factors
- obesity
- iron overload
sx and lab tests in this disease
Alcoholic steatosis
sx: usually asymptomatic, sometimes tender hepatomegaly
Labs: LFTs normal or mildly elevated, GGT HIGH
Reversible, usually doesn’t progress to steatohepatitis or cirrhosis
alcoholic hepatitis - ballooning of dying hepatocytes, inflammation in central and portal areas
clinical presentation of alcoholic hepatitis
alcohol use hx
fever
hepatomegaly
jaundice
anorexia
ascites sometimes
labs in alcoholic hepatitis
AST 2x ALT
increased GGT, alk phos, Bili, INR
decreased albumin
leukocytosis, thrombocytopenia, mild anemia, elevated MCV
how to tx alcoholic hepatitis
- supportive care - fluids, electrolytes, nutrition, vitamines, tx alcohol withdrawl
- corticosteroids - if severe (discriminant function score > 32)
- investigational tx: pentoxifylline - inhibits TNF synthesis
Alcoholic cirrhosis: only a small portion of pts progress to this point
- fatty liver, thick fibrous bands, lobules
tx for alcoholic cirrhosis
- abstinence
- tx of cirrhosis complications
- transplant
