questions 3

Alcoholic Liver Disease

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Topic updated on 08/01/17 7:06pm

Introduction
  • Chronic use results in three main disease processes
    • steatosis (fatty change)      
      • reversible state with cessation of alcohol
      • macrovesicular fatty change that can develop over the short term with moderate alcohol intake
        • contrast this from non-alcoholic fatty liver disease (NAFLD)
          • Patient's do not abuse alcohol, tend to be overweight and usually have an ALT > AST 
    • hepatitis
      • reversible state with cessation of alcohol
      • hepatocytes are enlarged with eosinophilic inclusions (Mallory bodies)
        • Mallory bodies are damaged intermediate filaments (cytokeratin) in hepatocytes
          • neutrophils are present
          • damage mediated by acetaldehyde
          • requires many years of continuous alcohol intake
        • cirrhosis
  • Pathophysiology
    • ethanol metabolism
      • presence of decreased NAD levels play a major role in altered metabolism
  • Risk factors
    • length of use
    • amount
    • women > men
Presentation
  • Symptoms and physical exam
    • fatty change
      • tender hepatomegaly
      • afebrile
    • hepatitis
      • tender hepatomegaly
      • fever
      • acities
    • cirrhosis
      • abdominal distention
      • altered mental status
      • tremor
      • fetor hepatis (foul smell of amines)
Evaluation
  • Labs
    • elevated AST and ALT
      • AST:ALT > 2 suggests alcoholic hepatitis
        • other liver pathologies have ALT > AST
        • inversed because AST is found in the mitochondria and EtOH is a mitochondiral toxin
    • absolute neutrophilic leukocytosis
      • seen in hepatitis but not fatty change
    • fasting hypoglycemia
    • ↑ anion gap metabolic acidosis
    • hypertriglyceridemia
    • hyperuricemia
    • thrombocytopenia
    • ↑ γ-gluamyltransferase
      • secondary to EtOH induced hyperplasia of the smooth ER
Treatment
  • Lifestyle
    • cessation of alcohol
  • Pharmacologic
    • steroids
  • Operative
    • transplant
Prognosis, Prevention, and Complications
  • Prognosis ranges from good to poor depending on early intervention and alcohol cessation
  • Early alcoholic liver changes (i.e. fatty liver) are reversible with lifestyle changes
  • Chronic hepatitis increases risk of hepatocellular carcinoma
  • Death from fulminant liver failure


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Qbank (1 Questions)

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(M1.GI.134) A 39-year-old Caucasian male presents for a physical exam. It is noticed that he has slight hepatomegaly. During the history, the patient states he drinks 7-8 beers daily. Biopsy of the liver is shown in Figure A. What is the primary mechanism for the abnormality seen in Figure A? Topic Review Topic
FIGURES: A          

1. Increased production of NAD
2. Decreased production of NAD
3. Increased fatty acid oxidation
4. Increased synthesis and exportation of lipoproteins
5. Increased uptake of fat

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