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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
Q

which type of hepatitis might present with a distaste for cigarette

A

Hep A

26
Q

what are the extra hepatic complications for hep a

A

arthritis
vasculitis
myocarditis
acute kidney injury

27
Q

what is the most common type of chronic hepatitis in the world

A

hep B

5% of people with acute will be chronically infected

28
Q

describe the stages of chronic Hep B infections

A

replicative –> hepatic inflammation, highly infectious

integrated –> HBeAg neg HBe ab pos

29
Q

how is hepatitis B spread

A

in high prevalence countries -> vertical/horizontal in childhood
in low prevalence countries –> sexual/blood contact

30
Q

what is vertical transmission

A

transmission from mother to child in utero

31
Q

what is horizontal transmission

A

person to person

32
Q

what is the relevance of different surface proteins on hep B virus

A

affects time to seroconversion (b<c)

and response to interferon treatment

33
Q

where is the prevalence of hep B highest

A

African

Middle and Far east

34
Q

what must be known before giving a hepatitis B vaccines

A

contains yeast therefore patient must not be allergic to yeast

35
Q

what are the first and second line treatments for hepatitis B

A

peginterferon

tenofovir (nucleotide reverse transcription inhibitor)

36
Q

what are the indications to treat hepatitis B

A

1) chronic infection
2) viral load > 2000IU/ml
3) evidence of ongoing liver damage

37
Q

which type of hepatitis co-infects with hepatitis B

A

hepatitis D

60-70% develop cirrhosis

38
Q

what type of virus is hepatitis C

A

single stranded RNA virus from Flaviviridae family

there are 6 genotypes

39
Q

where is hepatitis C most prevalent

A

Africa (esp Egypt)

40
Q

of those acutely infected with hep C how many will become chronically infecte

A

80%

41
Q

which treatments are used for the eradication of hep C

A

interferon
ribavirin
direct anti-virals (telaprevir/boceprivir)

42
Q

which polymorphism is associated with poor response to hep C treatment

A

homozygous IL-28
more common in asians
less common in afro-americans and afro-caribbeans

43
Q

which type of virus is hep E

A

entirely transmitted
spherical non-enveloped single stranded RNA virus
causes self limiting virus

44
Q

which patients can have chronic carriage of hep E

A

HIV and immunosuppressed

45
Q

what happens in phase I drug metabolism

A

makes molecules more polar

46
Q

what happens in phase II drug metabolisms

A

conjugation with endogenous substrates (glycine, acetic acid, sulphuric acid)

47
Q

at low concentrations how is ethanol metabolised

A

first pass hepatic metabolism
easily saturated
uses alcohol dehydrogenase
elimination largely independent of plasma concentration

48
Q

at high conc how is ethanol metabolised

A

second pass (MEOS)

49
Q

what 3 reactions happen in first pass metabolism of ethanol

A

oxidation of ethanol to acetaldehyde (uses ADH, reduces NAD)
acetaldehyde -> acetate (NAD dependant, uses acetaldehyde dehydrogenase)
acetate couple to coenzyme A

50
Q

what are the 2 outcomes of the first pass metabolism of ethanol

A

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
Q

which reduction reaction happens in the MEOS

A

reduction of NADPH to NADP+

produces free radicals as a byproduct –> hepatocellular damage

52
Q

what is measured on an LFT

A 
Bilirubin
AST (aspartate aminotransferase)
ALT (alanine aminotransferase)
ALP (alkaline phosphatase)
gamma- glutamyl transpeptidase
Albumin
53
Q

which markers on an LFT would be raised if there is hepatocellular damage

A

AST

ALT

54
Q

which markers on an LFT would be raised if there is obstruction to the outflow of bile

A

ALP

GGT

55
Q

what are the causes of hepatitic LFTS

A 
viral hepatitis
autoimmune hepatitis
drugs and toxins
alcohol
metabolic disorders (Wilson's)
fatty liver
malignancy
congestive cardiac failure
56
Q

what are the causes of cholestatic LFTs

A 
Gallstone in bile duct
Bile duct stricture
Cholangiocarcinoma
Pancreatic carcinoma
Nodes at the port hepatic
Ampullary carinoma
57
Q

what is low albumin and a prolonged PT a sign of

A

a failing liver

58
Q

in which sex is autoimmune hepatitis more common

A

four times more common in females

59
Q

besides heptocellular damage, what else causes a raised AST

A

heart, muscle and RBC breakdown

60
Q

besides cholestasis, what else causes a raised ALP

A 
bone disease
also released from
placenta
kidney
gut
leukocytes
61
Q

what causes raised bilirubin on an LFT

A
  • increased production (haemolysis)
  • impaired conjugation (hepatitis/cirrhosis/drugs)
  • Gilbert’s syndrome
  • Obstruction of drainage

Nutrition (11 decks)

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