Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

GI > Nonalcoholic fatty liver disease > Flashcards

Nonalcoholic fatty liver disease Flashcards

1
Q

define Non-alcoholic fatty liver disease

how much ethanol consumption in diagnsosis?

what type of hepatic steatosis?

A

An acquired liver disease in children and adults
Increased with the epidemic of obesity in the United States
Macrovesicular hepatic steatosis
Ethanol < 20 gm per day

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what two conditions under nonalcoholic liver disease?

A

Steatosis
Non-Alcoholic Steatohepatitis (NASH)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what is the epidemiology of NASH

how many adults; kids? by 2025?

A

NAFLD: 20-30% of adults, 10% of children
By 2025, over 25 million Americans are predicted to have NASH related liver disease
The next epidemic for liver disease

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

fatty liver:

how many normal individuals?

obese individulals?

NASH:

how many normal?

obese?

A

Fatty Liver:
10-15% of normal individuals
70-80% of obese
NASH:
3% of normal
15-20% of morbidly obese (BMI > 35)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

conditions associated with NAFLD (4)

how about race?gender? family?

A

Obesity
Type 2 Diabetes
Hyperlipidemia
Metabolic Syndrome

Race/Ethnicity
Mexican Americans have the highest
African Americans lowest

Gender
Initially 53-85% women
More recent studies 50:50
Familial component
? Dietary habits, genetics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what is the leading cause of pediatric liver disease?

A

10% of children have NAFLD
NAFLD: leading cause of Pediatric liver disease
130 patients with NAFLD with liver biopsy:
median age 12
87% had fibrosis, 20% had bridging fibrosis
In 100 children with NASH, 8% had advanced fibrosis and 3% had cirrhosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what nutritional abnormalities lead to NAFLD(2) ? metabolic diseases? (2)

A

Nutritional Abnormalities
Total Parenteral Nutrition
Starvation, Refeeding

Metabolic Diseases
Abetalipoproteinemia
Hypobetalipoproteinemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

which chemical exposures lead to NAFLD?

A

Occupational Chemical Exposure
Drugs
Tamoxifen
Corticosteroids
Amiodarone
Methotrexate
Anti-retroviral therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

which types of surgeries cause NAFLD?

A

Surgery – with rapid, excessive wt loss
Jejunoileal bypass
Gastric bypass – less common

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

natural history of fatty liver?

natural history of NASH?

What does NASH induce? what is it an increasing cause of?

A

Fatty Liver: limited progression

NASH: 30-40% with advanced fibrosis
10-15% with cirrhosis
NASH induced cirrhosis is an increasing cause of Hepatocellular Carcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what is steatosis a result of?

A

Steatosis: a result of disturbed balance
More lipogenesis/ increased FFA

normally:

Normally triglycerides incorporated into chylomicrons
Travel via lymphatics to peripheral fat
Hydrolyzed to free fatty acids
Stored in the liver
Oxidized by mitochondria
triglyceride/ cholesterol formation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

pathogenesis

insulin resistance:

insulin on glucose uptake? lipolysis? mitochondrial FA oxidation?

A

Insulin resistance
Insulin promotes the uptake of glucose
Stored as glycogen
Inhibits lipolysis
Increased levels of insulin lead to increased lipogenesis, increased FFA
Increased mitochondrial fatty acid oxidation
Free radical formation and damage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

obesity and pathogenesis of NAFLD:

A

Obesity
Increase in Synthesis of Free Fatty Acids (FFA)
Decrease in oxidation of FFA

Insulin Resistance
Increase in adipose tissue lipolysis
Increased FFA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

in NAFLD pathogeneisis what do increased FFA lead to? (2)

A
  • *Increase FFA leads to:**
    1. Fatty Liver
    2. Increased Oxidative Stress
    2a. Increased Free Radicals
    2b. Direct liver Injury
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what is the two hit pathogeneisis hypothesis of NAFLD?

A
  • *1. Hepatic fat accumulation**
  • *2. Oxidative Stress via lipid peroxidation and free radicals**
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q
A

know this

17
Q

what are four diseases that can combine with NASH for concomitant liver disease?

A

Hepatitis C + NASH
Hemochromatosis + NASH
Alpha 1 Antitrypsin Deficiency + NASH
Alcohol + NASH

18
Q

what are the clinical symptoms and signs of NAFLD

A

Most have no symptoms or signs of Chronic liver disease
Nonspecific symptoms: fatigue

19
Q

what is on the physical exam of a NAFLD patient? (4)

A

Obesity – 30-100% of patients
Hepatomegaly – up to 50%
Spider angiomata
Palmer erythema

20
Q

typical labs of NASH

Liver enzymes?

ALK phos?

A

In patients with NASH:
50-90% with elevated liver enzymes
AST and ALT: moderately elevated (up to 4 times normal)
Unlike Alcohol, AST is rare 2x ALT
Alkaline Phosphotase: up to 2 times normal

21
Q

what does NASH liver look like on US?

A

US: homogeneously fatty infiltrated liver, increased echogenicity throughout

22
Q

A “fatty” appearance on Ultrasound or CT does not make a ___________

A

A “fatty” appearance on Ultrasound or CT does not make a diagnosis

23
Q

how would you distinguis between steatotis and steatohepatitis?

A

BIOPSY!!!!

Helps to exclude other causes
Liver biopsy is the only definitive way to diagnose NASH
Helps to stage the disease

24
Q

define steatosis

A

Macrovesicular fat

25
Q

define steatohepatitis( 4 things)

BHIM

A

Inflammation, Hepatocyte degeneration, Ballooning and Mallory Bodies

26
Q

define fibrosis in NASH

when will cirrhosis occur?

A

Pericellular then Bridging

cirrhosis: 20% of patients in 10 years

27
Q

what is the histology of NASH?

A

Predominately Macrovesicular steatosis
Mallory Hyaline Hepatocyte ballooning

Perivenular and
perisinusoidal fibrosis
“Chicken wire appearance”

28
Q

how do you treat NASH(non-surgical)?

4

A
  1. WEIGHT reduction . weight reduction of 10% helpful
  2. if diabetic, optimize control
  3. if hyperlipidemic- treat this b/c of increased cardiac risk
  4. going herbal: coffee, 2 cups/day
29
Q

bariatic surgery helps NASH pts with BMI > than?

what does gastric banding improve?

A

Bariatric surgery may help people with NASH whose BMI is >35

Gastric banding associated with improvement in inflammation and even fibrosis

30
Q

what type of cirrhosis is caused by NASH?

Hepatitis C + NASH are increasing causes of ______\_and _______

A

NASH is felt to be a major cause of cryptogenic cirrhosis

Hepatitis C + NASH are increasing causes of cirrhosis and HCC

31
Q

t/fNASH may worsen the course of other liver diseases

A

true

32
Q

t/f

NASH has an increasing role as a cause of cirrhosis, HCC and liver transplantation

A

true

GI (2 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions