Lec 21 Alcoholic Liver Disease Flashcards
Are men or women more at risk for alcoholic liver disease? why?
women b/c they have lower activity of gastric mucosal alcohol dehydrogenase
What genetic association with alcoholic liver disease?
mutation in aldehyde dehydrogenase
What is threshold level of alchol for women/men each day?
80 g/day men and 20 g/day women
What are physical signs of alcoholic liver disease?
may have no symptoms
may have jaundice, spider nevi, hepatomegaly, splenomegaly
What are signs of alcoholic hepatitis?
fever, tachycardia increased WBC AST > ALT increased GGT, bilirubin portal HTN
What causes alcoholic steatosis?
alcohol oxidation causing excess accumulation of intracellular lipids
Is hepatic steatosis reversible?
yes
What 3 things characterize alcoholic hepatitis?
- steatosis
- hepatocellular necrosis
- acute inflammation
What zone of liver most affected by alcoholic hepatitis?
zone 3 of hepatic acinus
What are mallory bodies?
eosinophlic inclusions in hepatocytes; made of cytoskeletal intermediary filaments
What do you see on histology with alcoholic hepatitis?
- swollen and necrotic hepatocytes
- neutrophil infiltration
- mallory bodies
Why does presence of neutrophils suggest alcoholic hepatitis?
most other types of hepatitis present with lots of mononuclear cells [lymphocytes] not neutrophils
What do you see in alcoholic cirrhosis?
- deposition of collagen around terminal hepatic vein in chicken wire pattern
- micronodular cirrhosis
- shrunken liver
What is the specific pattern of fibrosis in alcoholic cirrhosis?
chicken wire deposition of collagen
What happens if you abstain from alcohol when you have alcoholic cirrhosis?
you get macronodular cirrhosis b/c normal regenerative response no longer impaired by alcohol
What do you see in non-alcoholic hepatic steatosis?
macronudlar, zone 3 predominant steatosis
hepatocellular ballooning
can progress to fibrosis and cirrhosis
What are some diseases associated with non-alcoholic hepatic steatosis?
- high BMI, triglycerides, insulin
- low HDL
- diabetes
== Metabolic syndrome
What is the pathophysilogy of non-alcoholic hepatosteatosis?
excess free fatty acids causing hepatocyte damage
What do you see on labs in NAFLD?
ALT > AST
elevated triglycerides
insulin resistance
Whats is NAFLD vs NASH?
NAFLD = non alcoholic fatty liver disease = spectrum of abnormalities includes hepatic steatosis alone or including necroinflammatory changes and fibrosis
NASH = nonalcoholic steatohepatitis = clinical pathological syndrome diagnosed by liver biopsy; requires that there be necrosis and inflammation
