Alcoholic Liver Disease

Question 1

List the stages of alcoholic liver disease?

Answer 1

1. Fatty liver (steatosis)
2. Alcoholic Hepatitis
3. Alcoholic Cirrhosis

Question 2

(1)

How does alcohol increase hepatic lipid?

Answer 2

It alters hepatocyte fat metabolism as synthesis is promoted and catabolism impaired.
Increased peripheral fat mobilisation.
Reduced lipoprotein synthesis.

Question 3

What apart from alcohol causes a fatty liver?

Answer 3

Obesity, T2DM, nutritional imbalance (e.g. after surgery), drugs (methotrexate, steroids).

Question 4

Describe the histology of hepatocytes in fatty liver disease.

Answer 4

Lipid droplets seen in hepatocytes (microvesiclular which then merge to macrovesicular).
Changes can be seen after 2 days excess alcohol - but rapid reversal on abstinence.

Question 5

How long does it take for alcholic hepatitis to develop?

Answer 5

3-5 years of alcohol abuse (but only in 1/3rd of alcoholics).

Question 6

Who is at greater risk of alcoholic hepatitis?

Answer 6

Females and those genetically susceptible.

Question 7

Describe the histology of alcoholic hepatitis.

Answer 7

Fatty liver plus ..
Ballooning (sub-lethal cell injury).
Mallory bodies (damaged intermediate filaments - ‘twisted rope appearance’).
Necrosis
Neutrophil polymorph infiltration.
Fibrosis - initially perivenular and pericellular (less oxygen). Later fibrous septa and maybe cirrhosis.

Question 8

What LFT changes would be seen in alcoholic hepatitis?

Answer 8

High transaminases.

Question 9

How many cases of alcoholic hepatitis develop into alcoholic cirrhosis?

Answer 9

1/3rd (10% of alcoholics).

Question 10

List complications of alcoholic cirrhosis?

Answer 10

Portal hypertension
Liver failure
Hepatocellular carcinoma

Question 11

What percentage of cirrhotic livers develop hepatocellular carcinoma?

Answer 11

80%