ALD Flashcards
What is the most effective therapy to reduce progression and reverse alcohol-associated liver disease (ALD)?
A. Glucocorticoids
B. Zinc supplementation
C. Prolonged alcohol abstinence
D. Liver transplantation
Correct Answer: C. Prolonged alcohol abstinence
Rationale: The most effective therapy for ALD is prolonged alcohol abstinence, which can reverse hepatic steatosis and steatohepatitis. Treatment of the underlying alcohol use disorder is a cornerstone of management.
What is the recommended surveillance for hepatocellular carcinoma (HCC) in patients with alcohol-associated cirrhosis?
A. CT scan every 3 months
B. Upper endoscopy every 12 months
C. Ultrasonography every 6 months
D. MRI every 6 months
Correct Answer: C. Ultrasonography every 6 months
Rationale: HCC screening in cirrhotic patients involves ultrasonography every 6 months to detect early-stage tumors for timely management.
A patient with alcoholic hepatitis has a Maddrey Discriminant Function (MDF) of 35. What is the recommended treatment approach?
A. Nutritional supplementation and zinc
B. Glucocorticoid therapy
C. N-acetylcysteine infusion alone
D. Multidisciplinary care without glucocorticoids
Correct Answer: B. Glucocorticoid therapy
Rationale: MDF ≥32 or MELD >20 indicates severe alcoholic hepatitis, where glucocorticoids (e.g., prednisolone 40 mg/day for 4 weeks) reduce short-term mortality.
What nutritional intervention is recommended for patients with alcoholic hepatitis?
A. Parenteral nutrition with high-protein formula
B. Enteral nutrition with >21 kcal/kg and zinc supplementation
C. High-fat diet with vitamin K supplementation
D. Low-calorie diet with no vitamin supplementation
Correct Answer: B. Enteral nutrition with >21 kcal/kg and zinc supplementation
Rationale: Enteral nutrition with adequate caloric intake and supplementation with micronutrients (e.g., zinc, vitamin B1) is crucial for managing nutritional deficiencies in alcoholic hepatitis.
What is a contraindication for glucocorticoid use in severe alcoholic hepatitis?
A. Hepatorenal syndrome
B. Active tuberculosis
C. MDF ≥32
D. Lille score <0.45
Correct Answer: A. Hepatorenal syndrome and B. Active tuberculosis
Rationale: Contraindications for glucocorticoid treatment include uncontrolled infections or sepsis, AKI and hepatorenal syndrome, uncontrolled upper gastrointestinal bleeding, concomitant diseases (including viral hepatitis, HCC, pancreatitis, DILI, active tuberculosis, and HIV), multiorgan failure, and shock
A patient with severe alcoholic hepatitis is being treated with glucocorticoids. On day 7, the Lille score is calculated as 0.6. What is the next step?
A. Continue glucocorticoid therapy
B. Add N-acetylcysteine infusion
C. Discontinue glucocorticoids and consider early liver transplantation
D. Increase the glucocorticoid dose
Correct Answer: C. Discontinue glucocorticoids and consider early liver transplantation
Rationale: A Lille score ≥0.45 after 7 days of glucocorticoid treatment indicates poor response, and glucocorticoids should be discontinued. Early liver transplantation may be considered.
Which therapy provides a short-term survival benefit in severe alcoholic hepatitis when combined with glucocorticoids?
A. Vitamin B12 supplementation
B. N-acetylcysteine infusion
C. Intravenous albumin
D. Zinc supplementation
Correct Answer: B. N-acetylcysteine infusion
Rationale: The combination of glucocorticoids with N-acetylcysteine infusion may provide additional short-term survival benefits at 1 month in patients with severe alcoholic hepatitis.
Which of the following laboratory findings is most characteristic of alcoholic liver disease (ALD)?
A. AST:ALT ratio <1
B. AST > ALT with AST/ALT ratio >1
C. AST >300 IU/L and ALT >400 IU/L
D. Normal serum bilirubin and INR
Correct Answer: B. AST > ALT with AST/ALT ratio >1
Rationale: ALD typically shows AST:ALT ratio >1 (often >1.5). Serum AST and ALT levels in alcoholic hepatitis usually do not exceed 400 IU/L.
A patient with suspected alcoholic hepatitis has the following lab results: AST 230 IU/L, ALT 150 IU/L, bilirubin 4 mg/dL, and INR 1.6. Which of the following findings supports the diagnosis of alcoholic hepatitis?
A. ALT > AST
B. AST/ALT ratio <1
C. AST/ALT ratio >1.5 and bilirubin >3 mg/dL
D. Bilirubin <3 mg/dL
Correct Answer: C. AST/ALT ratio >1.5 and bilirubin >3 mg/dL
Rationale: The diagnostic pattern for alcoholic hepatitis includes AST:ALT ratio >1.5 and serum bilirubin >3 mg/dL.
Which laboratory findings are common in a patient with alcohol-associated cirrhosis?
A. Elevated platelet count and normal INR
B. Elevated bilirubin, INR, and low platelet count
C. Normal liver function tests and bilirubin
D. ALT predominance and normal INR
Correct Answer: B. Elevated bilirubin, INR, and low platelet count
Rationale: Cirrhosis is associated with elevated bilirubin, prolonged INR, and thrombocytopenia due to portal hypertension and reduced liver synthetic function.
