Alcoholic Liver Dz

Question 1

What is normal bilirubin level? Conjugated?

Answer 1

Normal - 0.3-1.9

Conjugated 0-0.3

Question 2

What causes the majority of chronic liver dz? second most amt?

Answer 2

hep c then alcohol

Question 3

What are general characteristics of alcoholic liver dz?

Answer 3

steatosis, alcoholic hepatitis and alcoholic cirrhosis

Question 4

what does alcoholic cirrhosis predispose someone to?

Answer 4

HCC and cholangiocarcinoma

Question 5

What is the amt of alcohol and the length of time to lead to alc liv dz?

Answer 5

greater than 40-80 gm/day and more than 5 yrs duration

Question 6

What is the amt required to cause a woman to develop ald?

Answer 6

3 drinks/day

Question 7

what is the characteristic presentation of alcoholic hepatitis?

Answer 7

40-60 yo
greater than 80 mg/day for five years
rapid onset of jaundice, fever muscle wasting, ascited
heaptomegally with tenderness
ast and alt rarely over 300
ast>2xalt

Question 8

T or F with Alcoholic hepatitis

• leukocytosis
• decreased inr

Answer 8

• elevated leukocytosis

- elevated iNR

Question 9

what is the functional polymorphism assocaited with increased susceptibility to ald in east asians?

Answer 9

adh21

Question 10

in caucasian, what is the only known polymorphism associated with ald?

Answer 10

tnfa-238

Question 11

what results in endotoxemia mechanistically?

Answer 11

ethanol and acetyladehyde cause intestinal injury and increased permeability

Question 12

What cell is responsible for releasing cytokines and chemokines upon increased endotoxin levels?

Answer 12

kuppfer cells

Question 13

What is the two hit theory associated with ald?

Answer 13

1st - fatty liver (oxidative stress, increased nadh/nad ratio obesity and dm,
2nd - inflammation and necrosis, oxid stress/hypoxia/immunological rxns

Question 14

What is commonly also seen in people with advanced liver dz in alcoholics?

Answer 14

hep c

then hemachromatosis or alpha one antitrypsin def

Question 15

Does hep c or alcohol cause more cirrhosis?

Answer 15

hep c

Question 16

what hfe mutation increases cirrhosis likelihood in alcohlics?

Answer 16

c282y

Question 17

what is the spectrum of liver dz from steatosis to hcc?

Answer 17

steatosis, perivenular fibrosis, alcoholic hepatitis, sub-sinusoidal fibrosis - cirrhosis - hcc

Question 18

what are histo presentations of alcoholic liver dz?

Answer 18

perivenular fibrosis, megamitochondria, mallory bodies (made of precipitated keratin)