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Nutrition > Alcolic Liver Disease And Hepatitis > Flashcards

Alcolic Liver Disease And Hepatitis Flashcards

1
Q

what is alcoholic liver disease

A

a spectrum of disorders caused by chronic excessive consumption of alcohol

alcoholic steatosis&raquo_space; alcoholic hepatitis&raquo_space; chronic hepatitis

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2
Q

what is thought to exacerbate alcoholic liver damage

A

diet high in unseat fat
excess iron in the liver

susceptibility linked to:

  • ADH isoforms
  • cytokine expression of TNF alpha
  • collagen transcription
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3
Q

what are the signs of alcoholic hepatitis

A 
fever
jaundice
anorexia
malaise
hepatomegaly
signs of decompensation
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4
Q

what other clinical signs suggest chronic liver disease secondary to alcohol

A 
tremor
parotid enlargement
Dupuytren's contracture
Pseudo-Cushing's disease
Proximal myopathy
peripheral neuropahty
central signs (Wernickes/Korsakoffs)
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5
Q

what are the causes of cirrhosis

A

1) alcohol
2) chronic HBV/HCV
3) NASH (non alcoholic steatohepatitis)
4) autoimmune hepatitis
5) inherited (haemochromatosis, wilson’s alpha-antrypsin, CF)
6) intrahepatic biliary obstruction
7) extrahepatic biliary obstruction
8) drugs
9) cardiac failure
10) Budd-Chiari syndrome
11) Cryptogenic

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6
Q

what are the causes of ascites

A 
VENOUS HYPERTENSION
- cirrhosis
- congestive heart failure
- constrictive pericarditis
- Budd Chiari syndrome
- portal vein thrombosis
HYPOALBUMINAEMIA
- nephrotic syndrome
- malnutrition
MALIGNANT DISEASE (exudate
INFECTIONS eg peritoneal TB (exudate)
PANCREATITIS (exudate)
OVARIAN DISEASE (exudate)
MYXOEDEMA (hypothyroidism)
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7
Q

what is Budd-Chiari syndrome

A

occlusion of the hepatic veins usually by thrombosis or external compression

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8
Q

how is HCC diagnosed

A

ultrasound and alpha feto-protein

biopsy

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9
Q

what are the predisposing factors for HCC

A

HBV
HCV
Cirrhosis
aflatoxin (mould asperillus flavus)

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10
Q

what is the classic triad of symptoms in Wernicke’s encephalopathy

A

encephalopaty
occulomotor disturbance
gait ataxia

cause by teaming deficiency
treated with pabrinex and lactulose to prevent progression to Korsakoff’s syndrome

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11
Q

what types of central neurodegeneration can result from chronic consumption of alcohol

A 
seizures
Marchiafava Bignami (corpus callosum demyelination and necrosis)
Wernicke-Korsakoff
central pontine myelinolysis
cerebellar degeneration
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12
Q

what is Wilson’s disease

A

genetic AR disorder leading to the build up of copper in the body
presents with liver disease and neuropsychiatric symptoms
signs: Kayser-Fleischer rings in eyes

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13
Q

what are the signs of cirrhosis

A 
jaundice
anaemia
bruising
palmar erythema
dupuytran's contracture
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14
Q

what is cirrhosis

A

liver cell necrosis followed by nodular regeneration and fibrosis

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15
Q

what is hepatorenal sydrome

A

advanced cirrhosis with ascites and jaundice

low urinary volume and sodium

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16
Q

which non-viral agents can cause acute hepatitis

A 
toxoplasma gondii
leptospira icterhaemorrhagiae
coxiella burnetti (Qfever)
Mumps
drugs
alcohol
poisons:
- amanita phalloides (mushroom)
- aflatoxin
- carbon tetracholide
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17
Q

which viral agents can cause acute hepatitis

A 
ABCDE
EBV
CMV
yellow fever
adenovirus
herpes simplex
non-A non-E
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18
Q

which viruses can cause chronic hepatitis

A

BDC

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19
Q

what are the symptoms of the icteric phase of hepatitis

A 
dark urine
pale stool
jaundice
abdo pain
pruritus
arthralgia and skin rash
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20
Q

when are IgM and IgG levels highest during viral hepatitis

A

IgM –> when symptomatic

IgG –> post symptomatic

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21
Q

which type of virus is hepatitis A

A

a picornavirus

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22
Q

who is hepatitis A more common in

A

children and young adults
commonly seen in the autumn
it is notifiable in the UK

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23
Q

how is hepatitis A spread

A

faeco-oral route
overcrowding and poor sanitation
-> resistant to chlorination, killed by boiling water fore 10min

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24
Q

what changes on liver biochemistry with hepatitis A

A

prodromal -> bilirubinaemia and raised serum AST/ALT

icteric
AST max at 1-2days

prolonged PT if severe

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25
which type of hepatitis might present with a distaste for cigarette
Hep A
26
what are the extra hepatic complications for hep a
arthritis vasculitis myocarditis acute kidney injury
27
what is the most common type of chronic hepatitis in the world
hep B | 5% of people with acute will be chronically infected
28
describe the stages of chronic Hep B infections
replicative --> hepatic inflammation, highly infectious integrated --> HBeAg neg HBe ab pos
29
how is hepatitis B spread
in high prevalence countries -> vertical/horizontal in childhood in low prevalence countries --> sexual/blood contact
30
what is vertical transmission
transmission from mother to child in utero
31
what is horizontal transmission
person to person
32
what is the relevance of different surface proteins on hep B virus
affects time to seroconversion (b
33
where is the prevalence of hep B highest
African | Middle and Far east
34
what must be known before giving a hepatitis B vaccines
contains yeast therefore patient must not be allergic to yeast
35
what are the first and second line treatments for hepatitis B
peginterferon tenofovir (nucleotide reverse transcription inhibitor)
36
what are the indications to treat hepatitis B
1) chronic infection 2) viral load > 2000IU/ml 3) evidence of ongoing liver damage
37
which type of hepatitis co-infects with hepatitis B
hepatitis D | 60-70% develop cirrhosis
38
what type of virus is hepatitis C
single stranded RNA virus from Flaviviridae family | there are 6 genotypes
39
where is hepatitis C most prevalent
Africa (esp Egypt)
40
of those acutely infected with hep C how many will become chronically infecte
80%
41
which treatments are used for the eradication of hep C
interferon ribavirin direct anti-virals (telaprevir/boceprivir)
42
which polymorphism is associated with poor response to hep C treatment
homozygous IL-28 more common in asians less common in afro-americans and afro-caribbeans
43
which type of virus is hep E
entirely transmitted spherical non-enveloped single stranded RNA virus causes self limiting virus
44
which patients can have chronic carriage of hep E
HIV and immunosuppressed
45
what happens in phase I drug metabolism
makes molecules more polar
46
what happens in phase II drug metabolisms
conjugation with endogenous substrates (glycine, acetic acid, sulphuric acid)
47
at low concentrations how is ethanol metabolised
first pass hepatic metabolism easily saturated uses alcohol dehydrogenase elimination largely independent of plasma concentration
48
at high conc how is ethanol metabolised
second pass (MEOS)
49
what 3 reactions happen in first pass metabolism of ethanol
oxidation of ethanol to acetaldehyde (uses ADH, reduces NAD) acetaldehyde -> acetate (NAD dependant, uses acetaldehyde dehydrogenase) acetate couple to coenzyme A
50
what are the 2 outcomes of the first pass metabolism of ethanol
increased NADH:NAD+ - > increases lactate production (less pyruvate for gluconeogenesis) - -> decreased oxaloascetate for gluconeogenesis increased production of acetyl CoA -> production of fatty acids increased --> fatty liver
51
which reduction reaction happens in the MEOS
reduction of NADPH to NADP+ produces free radicals as a byproduct --> hepatocellular damage
52
what is measured on an LFT
``` Bilirubin AST (aspartate aminotransferase) ALT (alanine aminotransferase) ALP (alkaline phosphatase) gamma- glutamyl transpeptidase Albumin ```
53
which markers on an LFT would be raised if there is hepatocellular damage
AST | ALT
54
which markers on an LFT would be raised if there is obstruction to the outflow of bile
ALP | GGT
55
what are the causes of hepatitic LFTS
``` viral hepatitis autoimmune hepatitis drugs and toxins alcohol metabolic disorders (Wilson's) fatty liver malignancy congestive cardiac failure ```
56
what are the causes of cholestatic LFTs
``` Gallstone in bile duct Bile duct stricture Cholangiocarcinoma Pancreatic carcinoma Nodes at the port hepatic Ampullary carinoma ```
57
what is low albumin and a prolonged PT a sign of
a failing liver
58
in which sex is autoimmune hepatitis more common
four times more common in females
59
besides heptocellular damage, what else causes a raised AST
heart, muscle and RBC breakdown
60
besides cholestasis, what else causes a raised ALP
``` bone disease also released from placenta kidney gut leukocytes ```
61
what causes raised bilirubin on an LFT
- increased production (haemolysis) - impaired conjugation (hepatitis/cirrhosis/drugs) - Gilbert's syndrome - Obstruction of drainage

Nutrition (11 decks)

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