Non viral hepatitis

Question 1

MCC liver transplant

2nd MCC

Answer 1

Hep C

Etoh

Question 2

first pass metabolism

Answer 2

Veinous drainage from stomach drains to portal vein before reaching systemic circulation
20% that goes from stomach goes directly to liver first from portal vein

Question 3

this converts toxic alc to non toxic

Answer 3

ALDH2 is inhibited by Disulfiram (also Metronidazole, some Cephalosporins and Sulfonylureas)

Question 4

Earliest response of the liver to chronic alcohol consumption

Answer 4

alcoholic fatty liver disease

Transaminases (LFT) often normal or transiently elevated

Question 5

Generally the stage in-between fatty changes and cirrhosis

Answer 5

alcoholic hepatitis

Question 6

lab values

Answer 6

AST:ALT usually >2.0
AST and ALT usually <300 iu/L (chronic so not that high)
increased Bilirubin in majority of pts with ETOH hepatitis
GGT very sensitive

Question 7

chronic ETOH can lead to increased tylenol sensitivity

Answer 7

Suspect usage with transaminases >500 iu/L

Question 8

with abstinence this can be reversed

Answer 8

non-fibrotic liver damage

alc hepatitis or steatosis

Question 9

CIWA

Answer 9

etoh withdrawal assessment

Question 10

classic triad of confusion/ataxia/ophthalmoplegia

wernicke’s encephalopathy

Answer 10

thiamine (b1) deficiency

75% develop Korsakoff’s encephalopathy anterograde/retrograde amnesia, confabulation

Question 11

Fatty changes associated with obesity, hyperlipidemia, insulin resistance, malnutrition

Answer 11

Non alcoholic fatty liver disease

associated w/metabolic syndrome (insulin resistance, HTN, hyperlipidemia, low HDL)

Question 12

NAFLD tx

Answer 12

Wt loss, correcting dyslipidemia (diet, statins), alcohol avoidance

Question 13

Progression of fatty liver disease

Biopsy shows macrovesicular steatosis (fatty liver) and inflammation

Answer 13

non alcoholic steatohepatitis

Question 14

Autosomal recessive genetic defect → Impaired copper transport → Copper deposition in
liver, brain and cornea

Answer 14

Wilson’d disease
Keyser-fleischer rings, neuro problems
DX: Ceruloplasmin level, 24-hour urine copper measurement
TX: chelation, oral zinc

Question 15

Produced in the liver- protects the lungs from neutrophil elastase, an enzyme that can disrupt connective tissue
Liver, lung, dermatological and hematological manifestations

Answer 15

alpha 1 antitrypsin deficiency

Question 16

AI hepatitis is commonly seen in this population

Answer 16

adolescent females

Question 17

viking disease

Answer 17

Hereditary Hemochromatosis, increased Fe absorption

therapeutic phlebotomy, chelation