Pathophysiology of Liver Disease Flashcards
most common cause of fatty liver and second most common
alcohol first
NAFLD second
is alcohol a primary or secondary cause of fatty liver
secondary
name causes of fatty liver
NAFLD
alcohol
malnutrition and low protein diet
rapid weight loss
hepatitis C
HIV
Wilson’s disease
where is ethanol metabolised
in the liver
how does chronic alcohol intake cause fatty liver
a product of alcohol acetalhydrate causes NADH production
NADH increases lipogenesis and decreases fatty acid oxidation which leads to a fatty liver
how much alcohol intake is required to cause fatty liver
> 60g per day
are males or females more susceptible to alcoholic fatty liver
females
what does alcohol do to fat in the body
breaks down fat elsewhere in the body
this increases free lipids in the body
alcohol draws fat to the liver and causes it to esterify and stay in the liver
what histological features is diagnostic of alcoholic fatty liver
mallory’s hyaline bodies
what syndrome do almost all of those with a BMI > 35 have
the metabolic syndrome
what is the criteria for the metabolic syndrome
3 or more of the following:
abdominal obesity
- waist >102cm for men, >88cm for women
serum triglycerides >150mg/dl
HDL < 40 mg/dl for men, <50 for women
BP >130/85
Insulin resistance
- fasting blood glucose > 110mg/dl (6.1mmol/l)
- 2h >140mg/dl (7.8mmol/l)
risk factors for NAFLD
obese people
type 2 diabetes
genetic (small subgroup)
what can NAFLD progress to
non alcoholic steatohepatitis (NASH)
cirrhosis
hepatocellular cancer
what does NASH stand for
nonalcoholic steatohepatitis
what is steatosis
abnormal accumulation of fat in the liver
what changes in the liver characterise NASH
steatosis (fatty deposit)
inflammation
ballooning
+/- mallory hyaline
+/- fibrosis
what features characterise cirrhosis
inflammation
fibrosis stage 4
+/- steatosis
presentation of NAFLD and signs on investigation
asymptomatic
abnormal LFTs
right upper quadrant pain
fatigue
hepatomegaly
acathosis nigricans
who get acathosis nigricans and what is it
pigment on the neck
morbidly obese children
clinical features of NAFLD
obesity
hepatomegaly
stigmata of CLD
lab features of NAFLD
raised:
ALT
AST
GGT
glucose
HOMA-IR
total cholesterol
triglycerides
ferratin
transferrin
histological features of NAFLD
steatosis (fat accumulation)
inflammation
ballooning
necrosis
fibrosis
what is HOMA-IR
homeostasis model assessment of insulin resistance
equation for HOMA-IR
(fasting glucose x fasting insulin)/22.5
when in HOMA-IR important
in non diabetics
shows insulin resistance
what HOMA-IR shows severe insulin resistance
> 3
what is found within adipose tissue
it is a resevoir for hormones and cytokines
characteristic of acquired fat
it is proinflammatory
NAFLD treatment
gradual weight reduction
diet
exercise
anti-obesity agents
bariatric surgery
metformin
vitamin E
weight reduction rate in NAFLD
1.5kg per week
diet recommendations in NAFLD
low in carbohydrate and saturated fat
rich in polunsaturated fat, fibre, vit E and C
pathophysiology of cirrhosis
- fibrosis disrupts hepatic architecture
- disorganised regeneration of hepatocytes
complications of cirrhosis
portal hypertension
variceal bleeding
ascites
encephalopathy
liver failure
albumin, PT, urea and ammonia levels in cirrhosis
low albumin (liver can’t produce)
prolonged PT (no/less clotting factors)
low urea (can’t be metabolised from ammonia)
high ammonia (liver can’t clear(
albumin, PT, urea and ammonia levels in cirrhosis
low albumin (liver can’t produce)
prolonged PT (no/less clotting factors)
low urea (can’t be metabolised from ammonia)
high ammonia (liver can’t clear)
what vein is used instead of the route through the liver to get to the IVC and where is this found
coronary vein on cardia of stomach
definition of acute liver failure
loss of liver function that occurs quickly in days or weeks in a person with no pre-existing liver disease
causes of acute liver failure
paracetamol (staggered or intentional)
hep A and B
drug reactions
early presentation of acute liver failure
early presentation:
malaise
nausea
vomiting
abdominal pains
dehydration
late presentation of acute liver failure
late presentation:
acidosis
hypoglycaemia
coagulopathy
encephalopathy
renal failure
multi organ failure
