ALD,NALD,DILD

Question 1

what are the three stages of NAFLD?

Answer 1

simple steatosis, non-alcoholic steatohepatitis, and cirrhosis

Question 2

what exists in NASH that makes it different from steatosis?

Answer 2

inflammation

Question 3

what is tricky about NALFD-induced cirrhosis?

Answer 3

fat and inflammation may disappear

Question 4

what is the principle finding in NAFLD?

Answer 4

macrovesicular steatosis

Question 5

what are two theories on progression from steatosis to steatohepatitis (inflammation too)?

Answer 5

lipotoxicity theory (fat can beget inflammation) and 2 hit hypothesis (something else acting on the fat)

Question 6

untimately, ___ is the cause of inflammation in NASH

Answer 6

reactive oxygen species

Question 7

name 3 major histologic features seen in steatohepatitis (identical in non-alcoholic and alcoholic)

Answer 7

1. macrovesicular steatosis, 2. cytologic ballooning, 3. Mallory bodies (eosinophilic concretions)

Question 8

how common is the progression from NASH to cirrhosis, ESLD, and/or HCC?

Answer 8

common; about 20%

Question 9

what is the cure for NASLD that has progressed to cirrhosis?

Answer 9

transplant

Question 10

what are the major risk factors for NAFLD?

Answer 10

obesity, diabetes, inactivity, metabolic dz

Question 11

transaminase levels in NASLD are (low/normal/moderate/high)

Answer 11

moderate (less than 500); ALT>AST

Question 12

algorithm for diagnosing NASLD

Answer 12

repeat LFTs, screening tests, if negative screening and positive for echogenic ultrasound, then good clinical dx for NASLD

Question 13

name 2 non-invasive methods of assessing disease severity in NASLD

Answer 13

transient elastography (sound wave through liver); NAFLD Fibrosis Score followed by risk stratification

Question 14

what are the factors that contribute to NAFLD fibrosis score

Answer 14

age, BMI, diabetes, AST/ALT, platelets, albumin

Question 15

management of NAFLD

Answer 15

vitamin E has promise, but increases cancer risk; DIET AND EXERCISE BEST!

Question 16

describe to chronology of alcoholic liver dz

Answer 16

can be acute or chronic; often co-morbid with other liver dz

Question 17

diagnosis of alcoholic liver dz

Answer 17

AST: ALT ratio 2-3:1 (still not crazy high); can see elevated GGT with normal-ish AP

Question 18

name 4 extrahepatic lab findings in ALD

Answer 18

macrocytosis, folate/B12 deficiency, low BUN, thrombocytopenia

Question 19

how does alcoholic hepatitis (acute from binge/heavy drinking) differ clinically from the chronic form?

Answer 19

low grade fever, leukocytosis, hepatomegaly

Question 20

how to determine severity of acute alcoholic hepatits

Answer 20

equation that factors in prothrombin time and bilirubin

Question 21

tx for alcoholic hepatitis

Answer 21

prednisolone (cheaper) or pentoxifylline (blood viscosity reducer)

Question 22

name 3 drugs notorious for causing liver problems and 2 drugs that cause lots of liver problems bc of high use

Answer 22

methotrexate, tyelnol, statins are notorious; ABX and NSAIDS used so much

Question 23

subclinical DILI occurs with use of ____ (name 2) and results in high ____ which normalize when drugs are withdrawn

Answer 23

statins, NSAIDs; transaminases

Question 24

most common drug causes of acute liver injury

Answer 24

tylenol, augmentin (can be hepatic or cholestatic)

Question 25

chronic DILI may mimic ____ or ___ and ultimately lead to cirrhosis (____)

Answer 25

autoimmune dz (minocycline, NSAIDs), NAFLD (amiodarone), cirrhosis = methotrexate