Alcoholic Liver Disease

Question 1

What are the types of liver dz caused by alcohol? (3)

Answer 1

• hepatic steatosis or fatty change
• alcoholic (or steato-) hepatitis
• steatofibrosis up to and including cirrhosis

Question 2

What does hepatic steatosis look like? Is it reversible?

Answer 2

• microvesicular lipid droplets accumulating in hepatocytes, w/chronic ETOH use fat displaces the nucleus
• large, soft, greasy yellow liver
• NO FIBROSIS
• completely reversible if pt abstains from ETOH

Question 3

What does alcoholic steato-hepatitis look like?

Answer 3

• hepatocyte swelling and necrosis
• Mallory-Denk bodies
• – Mallory-Denk bodies = damaged intracellular eosinophilic aggregates of intermediate filaments in ballooning hepatocytes
• neutrophilic reaction to degenerating hepatocytes, especially those w/ MD bodies

Question 4

What does alcoholic steatofibrosis look like?

Answer 4

• fibrosis
• scarring in chicken-wire fence pattern
• lannec cirrhosis w/continuous use due to progressive inter-webbing of scars (large bands of fibrous tissue surrounding nodules
• liver is large, brown, shrunken and non-fatty

Question 5

What are risk factors for developing alcoholic cirrhosis?

Answer 5

• alcoholism
• female
• african american > caucasian
• iron overload = increased severity of liver DZ

Question 6

What is the pathogenesis of hepatocellular steatosis?

Answer 6

• impaired lipoprotein assembly and secretion
• increased peripheral catabolism of fat releases FFA’s into circulation
• shunting of substrates away from catabolism and towards lipid biosynthesis

Question 7

What is the pathogenesis of alcoholic hepatitis?

Answer 7

• acetaldehyde induced lipid peroxidation and protein adduct formation (carcinogen)
• induced CYP450 = increases conversion of other agents to form potentially toxic metabolites
• impaired methionine metab –> decreases glutathione levels
• alcohol causes release of bacterial LPS (proinflamm)
• release of endothelin (vasoconstriction)
• decreased perfusion of hepatic sinusoids

Question 8

What is the pathogenesis of alchoholic liver disease?

Answer 8

• it’s a chronic disorder of steatosis, hepatitis, progressive fibrosis and deranged perfusion

Question 9

Clinical signs of hepatic steatosis?

Answer 9

• hepatomegaly

- mild increase of serum bilirubin and alk phos levels

Question 10

What is a key lab finding in alcoholic liver disease?

Answer 10

ALT: AST > 2:1

Question 11

What are other lab findings in alcoholic hepatitis?

Answer 11

• increased bilirubin, alk phos, and serum aminotransferase
• neutrophilic leukocytosis
• malaise, anorexia, wt loss, abd discomfort

Question 12

What are the clinical findings in alcoholic cirrhosis?

Answer 12

• hepatic dysfunction (increased ALT/AST, bili, alk phos, hyperproteinemia)
• anemia
• may be clinically silent

Question 13

What are the clinical findings in end stage alcoholic hepatitis?

Answer 13

• hepatic coma
• massive GI hemorrhage
• intercurrent infection
• hepatorenal syndrome after bout of hepatitis
• HCC