ALD,NALD,DILD Flashcards
what are the three stages of NAFLD?
simple steatosis, non-alcoholic steatohepatitis, and cirrhosis
what exists in NASH that makes it different from steatosis?
inflammation
what is tricky about NALFD-induced cirrhosis?
fat and inflammation may disappear
what is the principle finding in NAFLD?
macrovesicular steatosis
what are two theories on progression from steatosis to steatohepatitis (inflammation too)?
lipotoxicity theory (fat can beget inflammation) and 2 hit hypothesis (something else acting on the fat)
untimately, ___ is the cause of inflammation in NASH
reactive oxygen species
name 3 major histologic features seen in steatohepatitis (identical in non-alcoholic and alcoholic)
- macrovesicular steatosis, 2. cytologic ballooning, 3. Mallory bodies (eosinophilic concretions)
how common is the progression from NASH to cirrhosis, ESLD, and/or HCC?
common; about 20%
what is the cure for NASLD that has progressed to cirrhosis?
transplant
what are the major risk factors for NAFLD?
obesity, diabetes, inactivity, metabolic dz
transaminase levels in NASLD are (low/normal/moderate/high)
moderate (less than 500); ALT>AST
algorithm for diagnosing NASLD
repeat LFTs, screening tests, if negative screening and positive for echogenic ultrasound, then good clinical dx for NASLD
name 2 non-invasive methods of assessing disease severity in NASLD
transient elastography (sound wave through liver); NAFLD Fibrosis Score followed by risk stratification
what are the factors that contribute to NAFLD fibrosis score
age, BMI, diabetes, AST/ALT, platelets, albumin
management of NAFLD
vitamin E has promise, but increases cancer risk; DIET AND EXERCISE BEST!
describe to chronology of alcoholic liver dz
can be acute or chronic; often co-morbid with other liver dz
diagnosis of alcoholic liver dz
AST: ALT ratio 2-3:1 (still not crazy high); can see elevated GGT with normal-ish AP
name 4 extrahepatic lab findings in ALD
macrocytosis, folate/B12 deficiency, low BUN, thrombocytopenia
how does alcoholic hepatitis (acute from binge/heavy drinking) differ clinically from the chronic form?
low grade fever, leukocytosis, hepatomegaly
how to determine severity of acute alcoholic hepatits
equation that factors in prothrombin time and bilirubin
tx for alcoholic hepatitis
prednisolone (cheaper) or pentoxifylline (blood viscosity reducer)
name 3 drugs notorious for causing liver problems and 2 drugs that cause lots of liver problems bc of high use
methotrexate, tyelnol, statins are notorious; ABX and NSAIDS used so much
subclinical DILI occurs with use of ____ (name 2) and results in high ____ which normalize when drugs are withdrawn
statins, NSAIDs; transaminases
most common drug causes of acute liver injury
tylenol, augmentin (can be hepatic or cholestatic)
chronic DILI may mimic ____ or ___ and ultimately lead to cirrhosis (____)
autoimmune dz (minocycline, NSAIDs), NAFLD (amiodarone), cirrhosis = methotrexate
