Alcoholic Liver Disease

Question 1

What are the types of alcoholic liver disease?

Answer 1

1) Fatty liver (all alcolics): always reversible if stop EtOH
2) Alcohlic hepatitis (35% alcoholics): usually reversible
3) Cirrhosis (10-15%): potentially irreversible

Question 2

What is the histology of alcoholic hepatitis?

Answer 2

Triad:

1) Hepatocyte necrosis w/ surrounding inflammation in zone 3
2) Hepatocellular ballooning with Mallory bodies (intracellular eosinophilic aggregates of cytokeratins); characteristically surrounded by neutrophils
3) Chicken wire fibrosis (network of interlobular CT in space of Disse and perivenular)

Question 3

Pathophysiology of fat accumulation in alcohlic liver disease?

Answer 3

EtOH oxidation to aldehyde

• reduces NAD+ to NADH
• Increased NADH decreases ATP supply to liver
• Impaired lipolysis so FAs and TGs accumulate
• Evokes immune reaction

Question 4

What are the effects of alcohol metabolism on the liver?

Answer 4

• relative hypoxia in zone III>I

- necrosis and hepatic vein sclerosis

Question 5

EtOH consumption predisposing to cirrhosis?

Answer 5

> 2/3/d in females and >3-6/d in males for >10y leads to cirrhosis.
Risk increases with amt above threshold.

Question 6

CFx severe alcohlic hepatitis?

Answer 6

-Stops drinking but feels unwell
-Low fever
-RUQ pain
-Increased WBC
Mimics RLL pneumonia and cholecystitis

Question 7

Ix alcohlic liver disease?

Answer 7

-AST:ALT >2:1 (usu

Question 8

Rx alcohlic liver disease?

Answer 8

• EtOH cessation
• Multivitamin (esp thiamine)
• Withold hepatoxics/ drugs metabolised by liver
• Prednisone 40mg OD x 28d if elevated bilirubin and INR (CIx renal failure, GI bleed, infection)

Question 9

Prognosis in alcoholic hepatitis wrt mortality?

Answer 9

• Immediate: 30-60% in first 6mo if severe
• Continued EtOH: 70% at 5y
• Cessation: 30% at 5y