Aetiologies/pathophysiology of liver disease Flashcards
what is NAFLD?
non alcoholic fatty liver disease
fatty liver or steato-hepatitis in absence of other cause
20-30% also have NASH
of these 20% get cirrhosis
what is the 2 hit paradigm for NAFLD?
first hit = excess fat accumulation
second hit = intrahepatic oxidative stress, lipid peroxidation, TNF alpha, cytokine cascade
what can be attributed to the second hit?
MCD diets
ischaemia reperfusion injury
lipopolysaccharide
Pro-inflammatory cytokine release
what single hits can cause NAFLD?
triglyceride benign
Skinny NASH
hepatocytes can generate TNF alpha
Oxidative stress at the centre of disease
what diseases is NAFLD associated with?
obesity type 2 disbetes hypertension low HDL cholesterol High triglycerides
how is simple steatosis managed?
diagnosed via US
weight loss and exercise
how is NASH managed?
diagnosis via liver biopsy
weight loss and exercise
experimental treatments
name some auto-immune liver diseases
primary biliary cholangitis (cirrhosis) auto-immune hepatitis primary sclerosing cholangitis alcohol related liver disease? drug reactions?
what causes PBC?
autoimmune component
T cell mediated
- CD4 cells reactive to M2 target, why loss of tolerance
how does PBC present?
middle aged women mostly usually asymptomatic/incidental fatigue itch without rash xanthelasma and xanthomas
how is PBC diagnosed?
2 of:
- positive AMA
- cholestatic LFTs
- liver biopsy
how is PBC treated?
Urseo deoxycholic acid
what are the possible outcomes of PBC?
most don’t develop symptoms or liver failure
itch can be a problem
