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Clinical GI Review > Liver Diseases > Flashcards

Liver Diseases Flashcards

1
Q

What is the primary objective in understanding the pathogenesis of alcoholic liver disease?

A

To utilize knowledge of cause to screen for patients at risk

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2
Q

What is the role of alcohol dehydrogenase in alcohol metabolism?

A

Linked to blood alcohol levels but NOT susceptibility to liver disease

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3
Q

What is the effect of genetic variability in acetaldehyde dehydrogenase?

A

Results in flushing reaction in populations linked to increased acetaldehyde build up

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4
Q

What is considered a direct hepatotoxin?

A

Alcohol

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5
Q

What initial condition results from alcohol ingestion?

A

Fatty liver

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6
Q

Is alcoholic hepatitis reversible with cessation of alcohol intake?

A

Potentially reversible in ~50% of cases

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7
Q

What are the clinical findings of alcoholic hepatitis?

A

Ballooning degeneration, spotty necrosis, PMN infiltrate with fibrosis

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8
Q

What is the 5-year survival rate for progressive alcoholic liver disease?

A

23%

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9
Q

What is the risk factor quantity for men that produces fatty liver?

A

40–80 g/d of ethanol

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10
Q

What is the increased susceptibility for women regarding alcohol consumption?

A

Amounts >20 g/d

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11
Q

What is the role of Hepatitis C in alcoholic liver disease?

A

Associated with younger age for severity, more advanced histology, and decreased survival

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12
Q

What is the significance of patatin-like phospholipase domain-containing protein 3 (PNPLA3)?

A

Linked to fatty liver

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13
Q

What is a standard drink defined as?

A

14 gm alcohol (or 0.6 fluid ounces)

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14
Q

What screening tool is used to determine alcohol use?

A

CAGE and AUDIT

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15
Q

What are common symptoms of alcoholic liver disease?

A

Nausea, RUQ discomfort, reported fever

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16
Q

What are some signs of alcoholic liver disease?

A

Hepatomegaly, fever, spider nevi, jaundice, portal hypertension/ascites

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17
Q

What laboratory test findings are common in alcoholic liver disease?

A

AST increased two- to sevenfold, ALT increased two- to sevenfold, AST/ALT usually >1 (or 2)

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18
Q

What is the significance of alcohol abstinence in treatment?

A

Possibility for reversal of disease in 50% of cases

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19
Q

What nutritional corrections should be made in patients with alcoholic liver disease?

A

Correct protein malnutrition, replace vitamins/minerals (A, D, thiamine, folate, zinc)

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20
Q

What is the first-line treatment for alcohol withdrawal?

A

Benzodiazepines

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21
Q

What is the 5-year survival rate following liver transplant for alcohol-related disease?

A

66-72%

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22
Q

What is the global burden of alcoholic liver disease related to?

A

2.5-3.3 million deaths (5.9%) annually

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23
Q

What countries are seeing an increase in cirrhosis related to alcohol consumption?

A

UK, Russia, Romania, Hungary

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24
Q

What is the increase in deaths due to alcoholic liver disease in the USA from 2014 to 2017?

A

From 19,388 to 22,246

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25
Q

True or False: Alcoholic liver disease is a preventable cause of morbidity/mortality.

A

True

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26
Q

What is hepatitis?

A

Inflammation of the liver resulting from infection or other causes.

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27
Q

Define cirrhosis.

A

Progressive liver disease with nodular regeneration, fibrosis, interference in function, and ultimately ending in liver failure.

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28
Q

What characterizes acute liver failure?

A

Acute liver injury with hepatic encephalopathy and elevated PT/INR.

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29
Q

How is chronic liver failure defined?

A

Liver failure typically greater than 26 weeks.

30
Q

What is portal hypertension?

A

Increased resistance to portal blood flow due to obstruction (prehepatic, intrahepatic, or posthepatic).

31
Q

Define ascites.

A

An accumulation of serous fluid in the peritoneal cavity.

32
Q

What is hepatic encephalopathy?

A

Neurologic changes ranging from changes in behavior to coma, secondary to elevated ammonia.

33
Q

What does asterixis refer to?

A

Nonrhythmic, rapid extension-flexion movements of head and extremities.

34
Q

What is steatosis?

A

Accumulation of fat in the liver.

35
Q

Define steatohepatitis.

A

Accumulation of fat in the liver with associated inflammation.

36
Q

What does NAFLD stand for?

A

Non-alcoholic fatty liver disease.

37
Q

What does NASH stand for?

A

Non-alcoholic steatohepatitis.

38
Q

List the possible causes of acute liver failure.

A
  • Acetaminophen
  • Hepatitis A
  • Hepatitis B
  • Hepatitis C
  • Drugs/toxins
  • Hepatitis D
  • Hepatitis E
39
Q

What are the symptoms of acute hepatic failure?

A
  • Jaundice
  • Hepatic encephalopathy
  • Coagulopathy
40
Q

What lab findings are associated with acute hepatic failure?

A
  • Elevated bilirubin
  • Elevated transaminases
  • Prolonged prothrombin time with INR >1.5
41
Q

What differentiates acute from chronic hepatic failure?

A

Acute if <26 weeks in duration, chronic if >26 weeks in duration.

42
Q

What are the leading causes of chronic liver failure?

A
  • Chronic Hepatitis B
  • Chronic Hepatitis C
  • Non-alcoholic fatty liver disease
  • Alcoholic liver disease
43
Q

What is the incubation period for Hepatitis A?

A

2-6 weeks.

44
Q

What is the transmission route for Hepatitis A?

A

Fecal-oral transmission.

45
Q

What serological marker is best for detecting acute Hepatitis A?

A

Anti-HAV (IgM).

46
Q

What does HBsAg indicate?

A

Hepatitis B infection (acute and chronic).

47
Q

What are the possible outcomes of Hepatitis B infection?

A
  • Acute Hepatitis
  • Chronic Hepatitis
  • Asymptomatic Carrier state
  • Acute Hepatic failure
48
Q

What is the key lab test for identifying active Hepatitis C infection?

A

HCV RNA testing.

49
Q

What is the incubation period for Hepatitis C?

A

4 to 26 weeks.

50
Q

What is a significant risk factor for Hepatitis C infection?

A

IV drug abuse.

51
Q

What is the mode of transmission for Hepatitis E?

A

Fecal-oral transmission.

52
Q

What is the mortality rate of Hepatitis E in pregnant women?

A

High (20%) mortality.

53
Q

Hepatitis E is most common in which regions?

A
  • Asia
  • India
  • Sub-Saharan Africa
  • Middle East
  • Mexico
54
Q

What is the significance of the window period in Hepatitis B infection?

A

HBsAg drops and Anti-HBs not elevated yet, indicating possible recovery or undetectable chronic infection.

55
Q

True or False: Hepatitis A can lead to chronic hepatitis.

56
Q

Fill in the blank: Chronic Hepatitis C is associated with a risk of _______.

A

[cirrhosis and hepatocellular carcinoma].

57
Q

What are the associated conditions for liver disease?

A
  • Right-sided heart failure (congestive-hepatopathy)
  • Diabetes mellitus
  • Skin pigmentation
  • Arthritis
  • Hemochromatosis
  • Obesity
  • Pregnancy
  • Inflammatory bowel disease / Celiac disease
58
Q

What is NASH?

A

Non-Alcoholic Steatohepatitis

NASH is characterized by hepatic inflammation and can lead to cirrhosis.

59
Q

What is the definition of Non-Alcoholic Fatty Liver Disease (NAFLD)?

A

Hepatic steatosis + exclusion of significant alcohol consumption + exclusion of secondary causes

NAFLD includes both NAFL and NASH.

60
Q

What are the risk factors for Non-Alcoholic Fatty Liver Disease?

A
  • Obesity
  • DM2
  • Dyslipidemia
  • Metabolic syndrome
  • PCOS
  • Hypothyroidism
  • Obstructive Sleep Apnea
  • Hypopituitarism
  • Hypogonadism
  • Previous cholecystectomy

These factors increase the likelihood of developing NAFLD.

61
Q

What is the difference between NAFL and NASH?

A

NAFL: Steatosis without evidence of significant inflammation
NASH: Has hepatic inflammation

NASH can be histologically indistinguishable from Alcoholic Steatohepatitis.

62
Q

What histological features are present in NASH?

A
  • Hepatic steatosis
  • Hepatocyte ballooning degeneration
  • Hepatic lobular inflammation
  • Prominent in centrilobular regions
  • Mallory-Denk bodies

A liver biopsy is the only way to differentiate NAFL from NASH.

63
Q

What are common clinical manifestations of NAFLD?

A
  • Asymptomatic
  • Fatigue
  • Malaise
  • RUQ abdominal discomfort
  • Possible hepatomegaly
  • Aminotransferase elevation

The degree of elevation does not predict the degree of inflammation or fibrosis.

64
Q

What imaging techniques can show steatosis in NAFLD?

A
  • Ultrasound
  • CT
  • MRI
  • MRS (spectroscopy)

None of these can differentiate NAFL from NASH.

65
Q

When should a liver biopsy be considered in NAFLD?

A
  • Stigmata of chronic liver disease (cirrhosis)
  • Splenomegaly
  • Cytopenias
  • Serum ferritin > 1.5 times upper normal
  • Age > 45 with associated obesity/DM

These factors indicate a higher risk of advanced liver disease.

66
Q

What are the differential diagnoses for NAFLD?

A
  • Alcoholic liver disease
  • Autoimmune hepatitis
  • Viral hepatitis
  • Wilson disease
  • Medications
  • Acute fatty liver of pregnancy
  • HELLP syndrome
  • Lipodystrophy
  • Starvation
  • Parenteral nutrition
  • Abetalipoproteinemia
  • Reye syndrome
  • Inborn errors of metabolism
  • Hemochromatosis
  • Alpha-1 antitrypsin deficiency

It is important to exclude these conditions before diagnosing NAFLD.

67
Q

What are the main treatment options for NAFLD?

A
  • Weight loss
  • Lifestyle modification
  • Bariatric surgery
  • Medications
  • Immunizations (hepatitis A, B, pneumococcal)
  • Address risk factors for CVD
  • Vitamin E (for advanced fibrosis without DM and CAD)
  • Avoid alcohol
  • Thiazolidinediones (insulin sensitizing)
  • Omega-3 fatty acids

Vitamin E may increase mortality in some cases.

68
Q

What laboratory tests are important for diagnosing hepatitis?

A
  • AST
  • ALT
  • ALK phosphatase
  • GGT
  • Bilirubin
  • LDH
  • Albumin
  • PT

Viral serology is also crucial for diagnosis.

69
Q

What are common symptoms of hepatitis?

A
  • Asymptomatic
  • Fatigue
  • Malaise
  • RUQ abdominal discomfort
  • Nausea
  • Vomiting
  • Itching
  • Fever
  • Jaundice

Acute severe hepatitis can present like acute liver failure but will lack encephalopathy.

70
Q

True or False: Fibrosis is required for the diagnosis of NASH.

A

False

Fibrosis is not a requirement for diagnosing NASH.

71
Q

What is a common misconception about aminotransferase elevation in NAFLD?

A

The degree of elevation does not predict the degree of inflammation or fibrosis

This is important for clinicians to understand when interpreting lab results.

72
Q

Fill in the blank: Hepatitis A cases in Arkansas from February 2018-2021 totaled ______.

A

482 cases

This statistic highlights the prevalence of Hepatitis A in that time frame.

Clinical GI Review (5 decks)

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