NASH/ASH & DILI

Question 1

AFLD

Answer 1

Alcoholic Fatty Liver Disease

Question 2

NAFLD

Answer 2

Non-Alcoholic Fatty Liver Disease

Question 3

ASH

Answer 3

Alcoholic Steatohepatitis

Question 4

NASH

Answer 4

Non-Alcoholic Steatohepatitis

Question 5

accumulation of triglyceride within hepatocyte cytoplasm; risk factors are metabolic syndromes and excessive alcohol consumption; NOT associated with inflammation or hepatocyte ballooning; REVERSIBLE with exercise and weight loss

Answer 5

Steatosis

Question 6

Steatosis is reversible with…

Answer 6

Exercise

Weight loss

Question 7

Alcoholic and Non-Alcoholic fatty liver disease are distinguished by histologic features (True or False)

Answer 7

False; must be done through clinical history/etiology

Question 8

NAFLD and AFLD encompass both simple steatosis and steatohepatitis (True or False)

Answer 8

True

Question 9

fat accumulation in hepatocytes WITH inflammation, hepatocyte ballooning and fibrosis

Answer 9

Steatohepatitis

Question 10

In addition to steatosis, what histologic features do you see in NASH and ASH?

Answer 10

Lobular inflammation, hepatocytes ballooning and fibrosis

Question 11

hepatocyte finding in steatohepatitis; cells are larger with pale swollen cytoplasm with clumps of cytoskeleton filaments, and a more rounded contour

Answer 11

Hepatocyte Ballooning

Question 12

As cirrhosis evolves in the setting on steatohepatitis, steatosis often becomes less apparent and is sometimes absent entirely (True or False)

Answer 12

True

Question 13

High triglycerides, Low HDL, Insulin resistance, Obesity, and HTN are risk factors for metabolic syndrome that can cause

Answer 13

Non-Alcoholic Fatty Liver Disease

Question 14

How can adipose tissue contribute to the progression of steatohepatitis?

Answer 14

Adipose tissue are actually active (can release a variety of pro-inflammatory factors

Question 15

How does Chronic Alcohol consumption contribute to Alcoholic Fatty Liver Disease

Answer 15

1) Endotoxin activates Kupffer cells to release cytokines
2) ETOH metabolism requires heavy O2 consumption (hypoxia)
3) Production of acetaldehyde (damages liver proteins and stimulates immune response)

Question 16

dense, eosinophilic aggregates of clumped cytoskeleton microfilaments in hepatocytes; seen in BOTH alcoholic and non-alcoholic steatohepatitis (far LESS in non-alcoholic though)

Answer 16

Mallory-Denk bodies (Mallory’s Hyaline)

Question 17

(NASH/ASH) is the most common chronic hepatic disorder in Western nation, sometimes silent until well advanced, with minimal to no abnormal LFTs

Answer 17

NASH

Question 18

The AST:ALT ratio for alcohol related Fatty Liver Disease/Steatohepatitis

Answer 18

> 2

Question 19

Treatment for NAFLD

Answer 19

1. Diet and exercise

2. Tx underlying metabolic syndrome

Question 20

Diagnosis of Alcoholic Liver Disease

Answer 20

1. H & P (identify alcoholism)
2. AST:ALT >2
3. Elevated GGT
4. Histologic findings

Question 21

Two main categories for drug-induced liver injury

Answer 21

Direct: injury due to drug metabolites
Indirect: Drug-induced immune mediated injury

Question 22

Histologic features of Drug-Induced Immune-Mediated liver injury

Answer 22

1. Inflammation with EOSINOPHILS

2. Numerous apoptotic hepatocytes (acidophil bodies)

Question 23

Notorious drug that cause toxic liver injury

Answer 23

Acetaminophen (Tylenol)

Question 24

Histologic features of Toxic-Injury to the liver (due to a drug metabolite)

Answer 24

1. Centrilobular necrosis with hepatocytes showing eosinophilic staining
2. Normal hepatocytes showing numerous mitotic figures (regenerating cells)

Question 25

What are some drugs notorious for drug-induced liver injury

Answer 25

1. Antibiotics
   - amoxicillin
2. NSAIDs
   - Ibuprofen
   - acetaminophen