Alcoholic Liver Disease: Waters

Question 1

Discuss the pathology of alcoholic liver dz.

Answer 1

Alcoholic steatosis
Alcoholic cirrhosis–> hepatocellular carcinoma, cholangiocarcinoma
Alcoholic hepatitis

Question 2

Describe the average pt w/ alcoholic liver dz based on how much they drink/day, presenting signs, symptoms, and labs.

Answer 2

> 80ml/day EtOH X >5 yrs
Rapid onset jaundice
Fever (systemic inflam), muscle wasting, ascites
Hepatomegaly w/ tenderness (fatty deposition)
AST, ALT rarely over 300
AST:ALT >2

Question 3

Describe the labs found in alcoholic hepatitis.

Answer 3

Elevated INR

Freq. leukocytosis

Question 4

Describe the two hit theory of alcoholic liver disease.

Answer 4

1st Hit: Fatty liver

• oxidative stress
• ^ NADH:NAD
• obseity, DM related to genetics and diet
• –> fat sensitized the liver to the 2nd hit

2nd Hit:

• inflammation/necrosis
• Oxidative stress/hypoxia, immunological rxn

Question 5

WILL BE ON TEST:

What are the 3 factors included in the MELD score (model of end stage liver dz)?

Answer 5

INR
Bilirubin
Creatinine

Question 6

The combination of these two factors contributes to the majority of liver disease cases:

Answer 6

EtOH + Hepatitis C

Question 7

Besides Hep C, what are two other complicating medical conditions that contribute to exacerbated alcoholic hepatic liver dz?

Answer 7

a1-antitrypsin deficiency

Hemochromatosis

Question 8

Describe the first histological change seen in an alcoholic liver.

Answer 8

Steatosis (fatty liver)

Question 9

Besides fatty changes, what other things will you see in a diseased liver from EtOH?

Answer 9

Hepatitis- inflammation, necrosis, Mallory-Denk bodies (intermediate filaments and ubiquinated proteins aggregated in cytoplasm of hepatocytes)
Cirrhosis- fibrosis, hyperplastic nodules (regenerative)

Question 10

Histologically, where are you going to first see the pathological changes of EtOH induced liver dz?

Answer 10

Zone 3 (centrolobular) - furthest from arterial blood supply

Question 11

Why does fatty liver occur in EtOH induced liver failure?

Answer 11

Shunting of normal substrates away from catabolism and toward lipid biosynthesis as a result of incr. levels of NADH
Impaired assembly and secretion of lipoproteins
Incr. peripheral catabolism of fat, this releasing FFAs into circulation

Question 12

Is steatosis specific to EtOH liver disease?

Answer 12

Kind of.
NOT found in viral/autoimmune hepatitis.
IS found in Non-alcoholic fatty liver disease.

Question 13

What percentage of alcoholics actually develop cirrhosis?

Answer 13

10-15%

Question 14

ALT and AST can be found in different proportions in EtOH and virally induced hapatitis. Describe the difference.

Answer 14

AST- elevated in EtOH “TOAST”

ALT- elevated in viral “VALT”