GI 205 Alcoholism and Hepatitis

Question 1

Describe the pathway of metabolism of alcohol in the liver

Answer 1

Alcohol dehydrogenase –> Acetaldehyde–> Acetate –> Acetyl CoA

Question 2

Why, in the metabolism of alcohol, is there a tendency towards hypoglycaemia and fatty acid accumulation

Answer 2

reduction of NAD+ is required in both reactions for the metabolism of alcohol
Accumulation of NADH
NADH inhibits gluconeogenesis and fatty acid breakdown

Question 3

Describe the stage of Fatty Liver/Alcoholic steatosis in chronic alcohol consumption

Answer 3

Fatty acids accumulate in the liver due to NADH inhibiting its breakdown
There is  increase FA release from fat
Decreased TAG excretion from the liver
Decreased FA oxidation
Increased lipid biosynthesis

Question 4

What investigations might be done and what would they show if a patient had a fatty liver?

Answer 4

Raised MCV
Elevation of both aminotransferases
Raised gamma GT
Histology/CT/US showing fatty infiltration

Question 5

Describe alcoholic hepatitis

Answer 5

Inflammation of the liver due to excess alcohol, this stage can be surpassed
Inflammatory cell infiltrates found in hepatocytes

Question 6

What are Mallory bodies?

Answer 6

Dense cytoplasmic inclusions seen in Hepatocytes in Alcoholic Hepatitis

Question 7

What will happen to the liver biochemistry in Alcoholic Hepatitis?

Answer 7

Raised: serum bilirubin, AST, ALT, ALP, PT and possible low serum albumin

Question 8

Describe the pathology of cirrhosis of the liver

Answer 8

Necrosis of hepatocytes
Fibrosis due to initiation and activation of stellate cells to myofibroblasts
Nodule formation - in alcohol usually micronodular which encompass the whole liver
Interference therefore with liver blood flow and function
= clinical features of portal hypertension and impaired hepatocyte function

Question 9

What would investigations show in cirrhosis of the liver?

Answer 9

Low serum albumin and PT indicate more severe cirrhosis
Liver biochemistry if often deranged
Low sodium indicates severe liver damage
Serum creatinine >130mcmols = wirse prognosis

Question 10

What blood test is a sign of hepatocellular carcinoma?

Answer 10

Raised alpha feto-protein

Question 11

List some of the clinical features of liver disease

Answer 11

Peristent jaundice
Ascites
Palmar erythema 
Caput medusa
Dupuytrens contracture
Spider naevi
Gynaecomastia
Umbilical hernia
Leuconychia
Clubbing
Oesophageal varices

Question 12

What three categories can you classify portal hypertension as?

Answer 12

Pre hepatic - blockage before the liver
Intra heptic - distortion of liver architechture (schistosomiasis or cirrhosis)
Post-hepatic - blockage outside the liver (rare)

Question 13

What two liver function enzymes mainly indicate acute hepatocellular injury if raised?

Answer 13

ALT and AST

Question 14

What liver enzyme is found in biliary liver cells and in bone so when raised can indicate a hepatic cholestatic injury?

Answer 14

ALP

Question 15

What are causes of intrahepatic cholestatic injury?

Answer 15

Gallstones, CA pancreas

Question 16

What are causes of extrahepatic cholestatic injury?

Answer 16

Viral cirrhosis, pregnancy, drugs

Question 17

What is the main protein made by the liver?

Answer 17

Albumin

Question 18

What does an increase in conjugated bilirubin indicate?

Answer 18

Obstructive jaundice

Question 19

What does an increase in unconjugated bilirubin indicate?

Answer 19

Haemolytic jaundice

Question 20

What is the most common viral hepatitis and how is it transmitted?

Answer 20

Hepatitis A - faeco-oral route through contaminated food and water

Question 21

What is the general life cycle of Hepatitis A?

Answer 21

Replicates inside the hepatocytes
RNA uncoats and binds to ribosomes
Synthesis of the viral genome by RNA polymerase
Particles excreted through faeces via the billiary tree

Question 22

What may you find on bloood investigations of HepA?

Answer 22

Slightly raised AST and ALT
Increased bilirubin if patient has jaundicce
Leucopenia
Lymphocytosis
Increased ESR

Question 23

What are the complications of HepA infection?

Answer 23

Cholestatic hepatitis
Fulminant liver failure
Relapsing HAV infection

Question 24

What main two Hep viruses are transmited through blood products and sexual contact?

Answer 24

Hep B and C

Question 25

What are the possible complications of a Hep B infection?

Answer 25

Chronic hepatitis, hepatocellular ca and cirrhosis/fibrosis

Question 26

What is the general presentation with hepatitis B infection?

Answer 26

Profound malaise, mild fever, RUQ ache, anorexia, nausea

Question 27

If there is chronic hepatitis B infection what indicates prognosis?

Answer 27

The levels of viral replication

Question 28

What hepatitis virus can only infect those with hepatitis B infection already?

Answer 28

Hepatitis D

Question 29

Which hepatitis virus will most likely become a chronic infection?

Answer 29

Hepatitis C

Question 30

What are other viral causes of hepatitis?

Answer 30

EBV, CMV, Herpes simplex

Question 31

What only two viruses causes chronic hepatitis?

Answer 31

Hep B and C

Question 32

What is the treatment for hepatitis B and C - in a chronic active infection

Answer 32

Antivirals - interferon, entecavir

Question 33

What toxic metabolite is produced by alcohol that depletes glutathione stores?

Answer 33

Acetaldehyde

Question 34

What is alcoholic steatosis?

Answer 34

Fat globules in the liver that obstruct venous flow and cause ischaemia

Question 35

What is the general treatment for Alcoholic liver disease?

Answer 35

Alcohol withdrawal and sedation to prevent withdrawal seizures
Vitamins B,C and K
Steroids
and possible liver transplant

Question 36

What is wernickes encephalopathy and why do alcoholics get it?

Answer 36

Thiamine deficiency - alcoholics have poor diet, required for production of the glutamate receptor