Exam 2 ALCOHOLIC LIVER DZ

Question 1

Zone of Liver?

Answer 1

Zone 1: Surrounds portal tracts, O2 blood from hepatic aa enters

Zone 2: b/w 1 and 3

Zone 3: Surrounds central vv, deO2 blood

Question 2

Portal Artery does?

Portal Vein does?

Answer 2

O2 blood to liver

GI blood to liver
Blood exits liver via hepatic vv into IVC

Question 3

Hepatic Steatosis is?

Answer 3

Fatty liver from alcoholic dz
Most C ALD
U no outward signs

Question 4

Hepatic Steatosis pathophys? (5)

Answer 4

↑ FFA moved from periph stores
↑ trigly prxdn
↓ FA oxidation
↓ lipoprotein release from liver

REVERSIBLE if EtOH stopped

Question 5

Non-Alcoholic Steatosis/Steatohepatitis caused by? (6)

Answer 5

Obesiety
DM
Meds: amiodarone (antiarrhy), glucocort, nifedipine (CCB)
Small bowel resection
Jejunoileal bypass
Peritoneal dialysis

Question 6

Alcoholic Hepatitis pathophys? (4)

Answer 6

Fatty infiltration,
Neutrophils infiltrate necrotic hepatocytes,
Eosinophilic intracellular clumping (Alcoholic Hyaline/Mallory Bodies),
Fibrosis around hepatic venules

Summary: Necrosis, Fibrosis, Mallory Bodies

Question 7

Alcoholic Hepatitis presentation? (7)

Answer 7

Asympt to severely ill:
Fever
Spider angiomas
Jaundice
Hepatomegaly w/ tenderness
Ascites/Edema
Oliguria, hypoNa+, hypoK+
Hepatic encephalopathy

Question 8

Alcoholic Hepatitis labs? (6)

Answer 8

AST&raquo_space; ALT (hepatic enzymes)
however, AST and ALT < 10x normal amount

GGTP (gamma glutamyl transpeptidase)&raquo_space; alkaline phosphatase

PTT = prolonged
Bilirubin = ↑
RBC macrocytosis = folate deficiency
Fe/Transferrin/Ferritin = ↑

Question 9

Alcoholic Hepatitis management? (6)

Answer 9

Hospitalize if seriously ill
Low Na+ diet
Diuretics
Folate
Monitor for encephalopathy
P steroids

Mild cases P reversible

Question 10

Cirrhosis pathophys?

Answer 10

Destruction of liver cells ->
Remodeling into nodules of regenerated hepatocytes + scaring

P Inflamm cell infiltration

Vasculature distortion -> ↑↑ blood flow bypasses scaring

Result is portal HTN, porto-systemic shunting, impaired liver fxn

Question 11

Cirrhosis Micronodular vs Macronodular?

Answer 11

Micro = from EtOH or hemochromatosis

Macro = from viral hepititis

Question 12

Cirrhosis presentation? (9)

Answer 12

Fatigue/Weak
Ascites/Edema
Dupuytrens contractures (thick palms)
Palmar erythema/spider angiomas
Jaundice
Man boobs/shrunken testicles
Venous collaterals of abd wall
Splenomegaly (-penias)
Weight loss/mm wasting

Question 13

Cirrosis labs? (5)

Answer 13

Similar to EtOH Hep
LFT = abnormal
Anemia (↓folate, hemolysis, ↓hematopoiesis, GI bleed)
Thrombocytopenia
Coag = abnormal (↓ clot factor prdxn)

Question 14

Cirrosis imaging? (3)

Answer 14

US for size, nodules, ascites
CT/MRI
Barium swallow for varices (varicose vv)

Question 15

Cirrosis tx? (4)

Answer 15

Supportive
Stop EtOH (NOT reversible but may ↓ decline)
Monitor e-, renal fxn, hemo, fluids
No acetamin

Question 16

Cirrosis complications? (4)

Answer 16

Portal HTN
Bacterial peritonitis
Hepatorenal synd
Hepatic encephalopathy

Question 17

Portal HTN caused by obstructions where? (3)

Answer 17

Prehepatic: portal vein thrombosis

Intrahepatic: cirrhosis

Posthepatic: CHF, constrictive percarditis

Question 18

Portal HTN leads to? (3)

Answer 18

Esoph varices/hemorrhoids
Splenomegaly
Ascites

Question 19

Portal HTN tx? (4)

Answer 19

Na+ restriction
Fluid restriction
Spironolactone + (P) loop
Transjugular intrahepatic portosystemic shunt (TIPS)

Question 20

TIPS procedure?

Beneficial?

Answer 20

stent b/w branch of hepatic vein and portal vein over catheter inserted thru jugular

Successful procedure but doesn’t ↑ survival

Question 21

Hepatorenal Syndrome a/w?

Presentation? (5)

Answer 21

End stage liver dz

Azotemia (↑BUN)
Oliguria
HypoNa+
Low urine Na+
HypoTN

Question 22

Hepatorenal Syndrome caused by?

Prognosis?

Answer 22

Unknown, dx of exclusion

Very poor

Question 23

Hepatic Encephalophathy/Portosystemic Encephalopathy is?

Assoc signs? (3)

Answer 23

Neuropsych syndrome w/ conscious, behavior, personality and neuro ∆s

Asterixis (flapping tremor or liver flap)
Distinct EEG ∆s
FETOR HEPATICUS (musty)

Question 24

Hepatic Encephalophathy caused by?

Answer 24

Hepatocellular dysfxn and portosystemic shunting ->
inability of liver to detox products from gut

AMMONIA most C toxin

Question 25

Hepatic Encephalophathy precipitated by? (6)

Answer 25

GI bleed
High protein diet
Alkalosis
HypoK+
Drugs
Infection

Question 26

Hepatic Encephalophathy disgnostics? (5)

Tx? (4)

Answer 26

Exclude other mentation disorders
Identify/correct precipitants
CBC, 
Chem panel, 
Ammonia levels

Protein restriction
Laxative
Neomycin or Metro
P liver transplant

Question 27

Hepatic Neoplasms: Benign? (3)

Answer 27

Hemangiomas
Nodular hyperplasia
Mesenchymal tumors (fibroma, lipoma, leiomyoma)

Question 28

Hepatocellular CA origin?

Answer 28

parenchymal cells (liver-specific fxn’l cells)

If from biliary duct = cholangiocarcimonas

Question 29

Hepatocellular CA caused by?

Answer 29

Cirrhosis (80%)
Hep B/C
And Chronic liver dz

Question 30

Hepatocellular CA presentation?

Answer 30

Cachexia (weak/weight loss/mm wasting)

Sudden ascites

Question 31

Hepatocellular CA diagnostics? (4)

Answer 31

Alk Phosph = ↑
Alpha-fetoprotein (AFP) = ↑
CT/MRI = preferred
Bx = DIAGNOSTIC

Bx not needed if imaging + and AFP ↑

Question 32

Hepatocellular CA tx?

Screening?

Answer 32

Surg, chemo, radio, transplant
Poor prognosis

All chronic Hep B
All cirrhosis from Hep C or EtOH

Q 6-12 mo w/ AFP and US