NASH-Jenkins Flashcards
How can alcohol lead to cirrhosis?
alcohol–> fatty liver (inc fat deposition in hepatocytes because inc in FFA) –> alcoholic hepatitis (inflammation)–> cirrhosis
***True or False: Alcohol is the most common cause of elevated AST/ALT
FALSE!
What is alcoholic hepatitis? What are the pathologic criteria?
-inflammation of the liver parenchyma (progression from fatty liver)
criteria:
- Mallory bodies**
- liver necrosis
- infiltration by neutrophils
- perivenular distribution of inflammation***
***What are the AST and ALT findings in alcoholic hepatitis?
AST:ALT 2:1 (or just AST> ALT)
What is alcoholic cirrhosis?
Fibrosis of liver parenchyma (scar tissue) due to inflammation (hepatitis) which was due to fatty liver
Which imaging tools can be used to diagnose fatty change and cirrhosis?
-ultrasound, *CT and MRI can be used
What is the treatment for alcoholic liver disease?
- Abstinence from alcohol
- Nutritional support
For Cirrhosis pts: prevention and management of ascites, spontaneous bacterial peritonitis, variceal bleeding, encephalopathy, malnutrition, and HCC
***What is the number one cause of AST and ALT elevation?
Non-alcoholic fatty liver disease (NAFLD)
–> NASH in particular***
What is morbid obesity?
patients who are 50-100% or 100 pounds above their ideal body weight
BMI > 39
What is NAFLD?
group of conditions where there is accumulation of excess fat in the liver of people who drink little or no alcohol
simple hepatic steatosis (simple fatty liver) –> NASH (non alcoholic steatohepatitis) –> cirrhosis (cryptogenic)
***Can diabetes, obesity, metabolic syndrome and high cholesterol cause cirrhosis?
YES!
NAFLD!!
What percentage of NASH pts get cirrhosis?
20%
What is the most common liver disorder in Western industrialized countries?
NAFLD!
How is NAFLD diagnosed?
-Elevated liver enzymes on routine labs.
-Liver ultrasounds or abdominal CT showing steatosis
-Blood serology to r/o viral hepatitis (Hep A, B, C, EBV, CMV, herpes)
Inquire about alcohol intake/history.
-ferritin and ANA to r/o hematochomatosis or autoimmune hepatitis
-History of metabolic syndrome risk factors.
-Liver biopsy if suspect inflammation and fibrosis (NASH)
***If a pt is obese and a diabetic with no elevation of AST and ALT, what is the diagnosis?
What about elevated AST and ALT?
- no abnormal liver enzymes=NAFLD
- Abnormal liver enzymes –> NASH*
What is the treatment for NAFLD?
-no medication to reverse it
modification of risk factors:
- weight loss and physical activity
- insulin sensitizers medication and other hypoglycemic meds
- lipid lowering meds
- antioxidants and anti-inflammatories
What is hereditary hemochromatosis?
- Autosomal Recessive disease of iron absorption
- Abnormal accumulation of iron in parenchymal organs, leading to organ toxicity.
***What is the best screening tool for hemochromatosis? Definitive diagnostic tool?
- Screen: ferritin level (high) (if you found that AST and ALT were elevated)
- Diagnosis: genetic testing for HFE 2 (juvenile hemochromatosis) or HFE 3 (adult form)
What are the typical signs and symptoms of hemochromatosis?
- 75% asymptomatic initially
- mild elevation of AST and ALT
- Elevated serum iron and ferritin
- symptoms: *skin bronzing/hyperpigmentation, fatigue, impotence, arthralgia, DM, cardiomyopathy
Who should be screened for hemochromatosis?
First-degree relatives of hemochromatosis
***What is the treatment for hemochromatosis?
- *phlebotomy to get rid of excess iron (weekly at first and then every 2-4 months to maintain)
- iron chelation therapy
- low iron diet
- *surgery when end-stage liver disease progresses despite the iron reduction
***True or False: Hemochromatosis is a rare disease
FALSE!
most common autosomal recessive disorder and most common inherited liver disease in white people
