Toxic and Metabolic Liver Disease (Quiz 3) Flashcards
what causes fatty liver diseases
- accumulation of triglycerides in the hepatocyte cytoplasm
risk factors for fatty liver disease
- metabolic syndrome
- excessive alcohol consumption
what is needed in addition to steatosis to establish the diagnosis of steatohepatitis
- lobular inflammation (inflammatory cells)
- hepatocyte ballooning
- hepatocyte death
- fibrosis
what is steatosis
what happens to the nucleus
- deposition of fat in hepatocyte cytoplasm
- nucleus pushed toward periphery
steatosis begins in which zone first
- centrilobular zone
will fibrosis reverse following reduction in risk factors
- no
what do we call a ballooned hepatocyte that is larger with a pale swollen cytoplasm and a cytoplasm containing clumped cytoskeletal filaments
what’s the hyaline cytoskeleton called
what condition are they usually indicative of
- Mallory-Denk bodies
- Mallory’s hyaline
- alcoholic steatohepatitis
the end stage of steatohepatitis is
- cirrhosis
as cirrhosis evolves _______ often becomes less apparent
- steatosis
without consumption of alcohol
what is the presence of >5% hepatic steatosis without evidence of hepatocellular injury
non-alcoholic fatty liver
without consumption of alcohol
what is the presence of >5% hepatic steatosis WITH evidence of inflammation/hepatocyte injury
non-alcoholic steatohepatitis
which ethnicity is at greatest risk for NAFLD
which gender
- hispanics
- men
what conditions can lead to metabolic syndrome
- elevated triglycerides
- low HDL
- insulin resistance
- obesity
- HTN
how does adipose tissue cause fatty liver disease
- releases proinflammatory factors (TNF-alpha, IL-6)
alcoholics absorb more _____ from the gut
then what happens
- endotoxin
- endotoxin activates Kupffer cells which secrete TNF-alpha and cause hepatocyte death
ETOH metabolism requires heavy _____ consumption
- causes what
- O2
- makes centrilobular zone more susceptible to hypoxia
toxic metabolite of alcohol metabolism
what happens
- acetaldehyde
- alters hepatocyte proteins which stimulate immune mediated injury
AST:ALT in NASH
AST:ALT in ASH
<1
> 2
best management for NAFLD
- diet and exercise
what criteria do we use to evaluate for underlying alcoholism
- CAGE
drug induced hepatitis includes inflammation from which cells
- eosinophils
- immune mediated
apoptotic hepatocytes in drug hepatitis called
- acidophil bodies
toxic injury from drug or drug metabolite versus drug hepatitis
toxic injury often due to
- no inflammation in toxic injury
- numerous mitotic figures
- Tylenol
drugs that are notorious for causing liver problems
- methotrexate
- tylenol
- statins
most common causes of DILI
- antibiotics
- NSAIDS
subclinical DILI often seen with
- statins
- NSAIDS
- antibtiocs
acute liver injury DILI often seen with
- tyenol
- amoxicillin-clavulanate (augmentin)
DILIs from chronic liver injury that may mimic autoimmune disease due to
- minocycline
- NSAIDS
DILIs from chronic liver injury that induce NAFLD
- amiodarone
- tamoxifen
DILIs from chronic liver injury that lead to fibrosis and cirrhosis
- methotrexate
