Alcoholic Liver Dz Flashcards

1
Q

What is normal bilirubin level? Conjugated?

A

Normal - 0.3-1.9

Conjugated 0-0.3

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2
Q

What causes the majority of chronic liver dz? second most amt?

A

hep c then alcohol

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3
Q

What are general characteristics of alcoholic liver dz?

A

steatosis, alcoholic hepatitis and alcoholic cirrhosis

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4
Q

what does alcoholic cirrhosis predispose someone to?

A

HCC and cholangiocarcinoma

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5
Q

What is the amt of alcohol and the length of time to lead to alc liv dz?

A

greater than 40-80 gm/day and more than 5 yrs duration

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6
Q

What is the amt required to cause a woman to develop ald?

A

3 drinks/day

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7
Q

what is the characteristic presentation of alcoholic hepatitis?

A
40-60 yo
greater than 80 mg/day for five years
rapid onset of jaundice, fever muscle wasting, ascited
heaptomegally with tenderness
ast and alt rarely over 300
ast>2xalt
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8
Q

T or F with Alcoholic hepatitis

  • leukocytosis
  • decreased inr
A
  • elevated leukocytosis

- elevated iNR

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9
Q

what is the functional polymorphism assocaited with increased susceptibility to ald in east asians?

A

adh21

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10
Q

in caucasian, what is the only known polymorphism associated with ald?

A

tnfa-238

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11
Q

what results in endotoxemia mechanistically?

A

ethanol and acetyladehyde cause intestinal injury and increased permeability

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12
Q

What cell is responsible for releasing cytokines and chemokines upon increased endotoxin levels?

A

kuppfer cells

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13
Q

What is the two hit theory associated with ald?

A

1st - fatty liver (oxidative stress, increased nadh/nad ratio obesity and dm,
2nd - inflammation and necrosis, oxid stress/hypoxia/immunological rxns

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14
Q

What is commonly also seen in people with advanced liver dz in alcoholics?

A

hep c

then hemachromatosis or alpha one antitrypsin def

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15
Q

Does hep c or alcohol cause more cirrhosis?

A

hep c

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16
Q

what hfe mutation increases cirrhosis likelihood in alcohlics?

A

c282y

17
Q

what is the spectrum of liver dz from steatosis to hcc?

A

steatosis, perivenular fibrosis, alcoholic hepatitis, sub-sinusoidal fibrosis - cirrhosis - hcc

18
Q

what are histo presentations of alcoholic liver dz?

A

perivenular fibrosis, megamitochondria, mallory bodies (made of precipitated keratin)