Week 6: Alcoholic liver disease, NAFLD, cirrhosis

Question 1

Describe the progression of the stages of NAFLD to hepatocellular carcinoma

Answer 1

Normal liver ->Steatosis -> Steatohepatitis -> Cirrhosis -> Hepatocellular carcinoma

Question 2

Risk factors for developing NAFLD

Answer 2

• Overweight/ obese/sedentary individuals

* T2DM/ metabolic syndrome

Question 3

Which liver enzymes and immunoglobulins are raised in NAFLD

Answer 3

++ALT, ++GGT

++ IgA

Question 4

How does a fatty liver show up on USS

Answer 4

Bright (hyperechoic) liver

Question 5

Describe management of NAFLD

Answer 5

1. Treating risk factors eg obesity

2. Liver transplant (in end stage disease)

Question 6

Describe the progression of the stages of Alcoholic Liver Disease

Answer 6

Steatosis -> Steatohepatitis + fibrosis -> cirrhosis

Question 7

Histologically, what does steatosis look like

Answer 7

Hepatocytes containing macrovesicular droplets of triglycerides

Question 8

What is the cardinal sign in steatohepatitis

Answer 8

Rapid onset of jaundice

Question 9

What liver enzymes are raised in alcoholic hepatitis? What would their ratio be

Answer 9

++AST, ++ALT

AST:ALT >2

(absolute values for both should be <500, otherwise suggests acute hepatitis due to another cause)

Question 10

What kind of anaemia can occur with alcoholic liver disease

Answer 10

Macrocyctic anaemia

Question 11

Which substance predicts development of hepatorenal syndrome from ARLD

Answer 11

Raised creatinine

Question 12

3 investigations in screening for HCC

Answer 12

1. AFP
2. Fibroscan
3. Liver biopsy