Fatty Liver Disease

Question 1

T/F histologically, alcohol and non alcohol FLD looks the same

Answer 1

T –> can only differentiate based on hx and enzymes

Question 2

Spectrum of alcohol liver disease

Answer 2

fatty liver –> hepatitis –> cirrhosis

Question 3

How much alcohol is too much?

Answer 3

maximally 1-2 units of wine/day

Question 4

Risk factors for alcohol liver disease

Answer 4

alcohol consumption, alcoholism, diet/nutrition, coinfection, genetic

Question 5

Normal alcohol metabolism

Answer 5

alcohol (+ADH)–> acetaldehyde +NADH (+ALDH) –> acetate + NADH

Question 6

Binge alcohol metabolism

Answer 6

Excess alcohol is converted to NADP+ and O2- by MEOS–> free radicals

Question 7

Pathogenesis of alcohol fatty liver

Answer 7

increase nadh –> increase fatty acid synthesis/decrease beta oxidation –> accumulation in hepatic cytoplasm –> esterification and storage as TG –>FATTY LIVER

Question 8

When does alcohol/alcohol fatty liver cause liver damage?

Answer 8

ROS damage, lipid peroxidation, kupffer cell activation + cytokine release (TNFalpha and TGFbeta and superoxide)

Question 9

How does alcohol cause fibrosis?

Answer 9

steallate cells activated by acetaldehyde, ROS, products of peroxidation, TGF beta –> produce collagen

Question 10

T/F fatty liver is reversible

Answer 10

T

Question 11

T/F alcohol hepatitis and cirrhosis are reversible

Answer 11

F

Question 12

Findings in fatty liver

Answer 12

mild to moderate increase in AST/ALT, malaise, tenderness

Question 13

Tx of fatty liver

Answer 13

discontinue EtOH

Question 14

Findings in alcohol hepatitis

Answer 14

after years of drinking –> weakness, anorexia, nausea, vomiting, portal hypertension findings, jaundice, palmar erythema, increase prothrombin time, asterixis, ascites, 2:1 AST:ALT, increase bilirubin

Question 15

Histologic findings of alcohol hepatitis

Answer 15

poly infiltrates, mallory bodies, ballooning degeneration

Question 16

Prognostic factors in alcohol hepatitis

Answer 16

maddrey discriminant function, continued alcohol use

Question 17

Tx of alcohol hepatitis

Answer 17

stop etoh, nutrition, steroids/pentoxifylline, tx for infection

Question 18

NAFLD

Answer 18

looks like alcohol liver injury w/ no history of alcohol

Question 19

Major etiologic factor in NAFLD

Answer 19

obesity –> manifestation of metabolic syndrome –> insulin resistance + oxidative stress of hepatocytes

Question 20

Pathogenesis of NAFLD

Answer 20

hyperinsulinemia –> increased lipolysis, increased glycolysis, and decrased apoB production for FA transport in VLDL –> increased FFA –> accumulation of FFA –> ROS production –> lipid peroxidation

Question 21

How do we differentiate between NASH and alcohol liver disease?

Answer 21

NASH = more women, more diabetes/obesity, fewer symptoms, lower AST:ALT ratio, less fibrosis/cirrhosis

Question 22

Tx of NAFLD

Answer 22

lose weight! –> improves insulin resistance, reverse steatosis, reverse injury/inflammation/fibrosis

• can use insulin sensitizing agents (rosiglatazone, metformin) + antioxidants (VitE)