Patterns of liver injury

Question 1

evolution of fatty liver disease

Answer 1

Hepatic steatosis, steatohepatitis, fibrosis/cirrhosis, CA (HCC)

Question 2

what is metabolic syndrome

Answer 2

central (around waist) obesity, DM 2, HTN, dyslipidemia

Question 3

What causes macrovesicular fatty liver

Answer 3

nurtritional (obesity, TPN), metabolic (DM, hyperlipidemia), drug-related (EtOH, corticosteroids)

Question 4

what causes microvesicular fatty liver

Answer 4

pregnancy, Reye’s syndrome, tetracyclines

Question 5

Lipogranulomas

Answer 5

cause lipoapoptosis. Exposure of non-adipose tissue (heliver) to excess long-chain FAs

Question 6

PPARalpha

Answer 6

becomes defective/overloaded in fatty liver dz.

Question 7

PPAR alpha vs gamma

Answer 7

alpha is signaled when fat comes into system and helps burn fat. Gamma stores fat

Question 8

what pattern of drinking contributes more to liver damage: binge or steady

Answer 8

steady

Question 9

ADH/ALDH2 pathway of alcohol metabolism

Answer 9

EtOH converted by Alcohol dehydrogenase (ADH) to acetaldehyde (toxic) in the cytosol which aldehyde dehydrogenase (ALDH2) then converts to acetate in the mitochondria.

Question 10

Mutations in alcohol metabolism

Answer 10

most asians have mutant ADh that metabolizes EtOH faster resulting in acetaldehyde accumulation. ALDH2 mutation in some groups leads to inactivity and acetaldehyde buildup.

Question 11

CYPs in EtOH metabolism

Answer 11

2E1. Generates ROS which damage hepatocytes and stimulate stellate cells to make collagen

Question 12

three histo features of alcoholic hepatitis

Answer 12

necrosis, Mallory bodies, PMN infiltration

Question 13

two major effects of acetaldehyde on liver

Answer 13

stellate cell activation leading to fibrosis. Steatohepatitis by altering metabolism and leading to hepatocyte death