Liver Disease

Question 1

A pt presents with fatty liver, alcoholic hepatitis, and cirrhosis, and labs show decreased Alks. What disease do they have?

Answer 1

Alcoholic Liver Dz

Question 2

A 45 yo hispanic male presents with non-specific constitutional symptoms and vague RUQ discomfort. You note that he is obese, and you have ruled out several causes of RUQ pain (cholecystitis, pancreatitis, Crohn’s, Celiac’s, etc.). AST and ALT are 3x UNL and AST:ALT

Answer 2

NAFLD
U/S (60-90% sensitive, 90% specific)
Biopsy for steatosis

Question 3

A 14 yo white obese boy presents for his annual check up. You order LFTs, which come back with AST & ALT 2 x ULN and AST:ALT = 0.8. U/S shows fat accumulation in the liver but no inflammation. What diseases is this condition associated with? How do you treat?

Answer 3

NAFLD
Assoc. w/ insulin resistance, metabolic syndrome, obesity, hypertriglyceridemia, mixed dyslipidemia
Most don’t progress, but some NDFLD –> NASH –> cirrhosis

Question 4

A 45 yo Hispanic male presents for his annual check up. He has a history of NAFLD and you are worried he might progress to NASH. How can you determine if he has?

Answer 4

Liver biopsy will show steatosis WITH fibrosis and inflammation (NASH)

Question 5

A 39 yo obese white male presents with vague RUQ discomfort and non-specific constitutional symptoms. After ruling out other causes of RUQ pain, you do a liver biopsy which shows steatosis with fibrosis and inflammation. How should you treat this pt?

Answer 5

NASH
Liver transplant!
Lifestyle: weight loss
Meds: weight loss, bariatric surgery, manage dyslipidemia/DM/metabolic syndrome, vitamin E, statins, insulin sensitizing agents