Pathophysiology of Liver Disease Flashcards by Emily White

most common cause of fatty liver and second most common

alcohol first
NAFLD second

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is alcohol a primary or secondary cause of fatty liver

secondary

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name causes of fatty liver

NAFLD
alcohol
malnutrition and low protein diet
rapid weight loss
hepatitis C
HIV
Wilson’s disease

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where is ethanol metabolised

in the liver

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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

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how much alcohol intake is required to cause fatty liver

> 60g per day

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are males or females more susceptible to alcoholic fatty liver

females

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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

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what histological features is diagnostic of alcoholic fatty liver

mallory’s hyaline bodies

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what syndrome do almost all of those with a BMI > 35 have

the metabolic syndrome

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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)

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risk factors for NAFLD

obese people
type 2 diabetes
genetic (small subgroup)

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what can NAFLD progress to

non alcoholic steatohepatitis (NASH)
cirrhosis
hepatocellular cancer

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what does NASH stand for

nonalcoholic steatohepatitis

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what is steatosis

abnormal accumulation of fat in the liver

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what changes in the liver characterise NASH

steatosis (fatty deposit)
inflammation
ballooning
+/- mallory hyaline
+/- fibrosis

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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

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

1. fibrosis disrupts hepatic architecture 2. 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