Toxic and Metabolic Liver Disease (Quiz 3) Flashcards

1
Q

what causes fatty liver diseases

A
  • accumulation of triglycerides in the hepatocyte cytoplasm
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2
Q

risk factors for fatty liver disease

A
  • metabolic syndrome

- excessive alcohol consumption

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3
Q

what is needed in addition to steatosis to establish the diagnosis of steatohepatitis

A
  • lobular inflammation (inflammatory cells)
  • hepatocyte ballooning
  • hepatocyte death
  • fibrosis
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4
Q

what is steatosis

what happens to the nucleus

A
  • deposition of fat in hepatocyte cytoplasm

- nucleus pushed toward periphery

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5
Q

steatosis begins in which zone first

A
  • centrilobular zone
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6
Q

will fibrosis reverse following reduction in risk factors

A
  • no
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7
Q

what do we call a ballooned hepatocyte that is larger with a pale swollen cytoplasm and a cytoplasm containing clumped cytoskeletal filaments

what’s the hyaline cytoskeleton called

what condition are they usually indicative of

A
  • Mallory-Denk bodies
  • Mallory’s hyaline
  • alcoholic steatohepatitis
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8
Q

the end stage of steatohepatitis is

A
  • cirrhosis
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9
Q

as cirrhosis evolves _______ often becomes less apparent

A
  • steatosis
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10
Q

without consumption of alcohol

what is the presence of >5% hepatic steatosis without evidence of hepatocellular injury

A

non-alcoholic fatty liver

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11
Q

without consumption of alcohol

what is the presence of >5% hepatic steatosis WITH evidence of inflammation/hepatocyte injury

A

non-alcoholic steatohepatitis

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12
Q

which ethnicity is at greatest risk for NAFLD

which gender

A
  • hispanics

- men

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13
Q

what conditions can lead to metabolic syndrome

A
  • elevated triglycerides
  • low HDL
  • insulin resistance
  • obesity
  • HTN
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14
Q

how does adipose tissue cause fatty liver disease

A
  • releases proinflammatory factors (TNF-alpha, IL-6)
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15
Q

alcoholics absorb more _____ from the gut

then what happens

A
  • endotoxin

- endotoxin activates Kupffer cells which secrete TNF-alpha and cause hepatocyte death

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16
Q

ETOH metabolism requires heavy _____ consumption

  • causes what
A
  • O2

- makes centrilobular zone more susceptible to hypoxia

17
Q

toxic metabolite of alcohol metabolism

what happens

A
  • acetaldehyde

- alters hepatocyte proteins which stimulate immune mediated injury

18
Q

AST:ALT in NASH

AST:ALT in ASH

A

<1

> 2

19
Q

best management for NAFLD

A
  • diet and exercise
20
Q

what criteria do we use to evaluate for underlying alcoholism

A
  • CAGE
21
Q

drug induced hepatitis includes inflammation from which cells

A
  • eosinophils

- immune mediated

22
Q

apoptotic hepatocytes in drug hepatitis called

A
  • acidophil bodies
23
Q

toxic injury from drug or drug metabolite versus drug hepatitis

toxic injury often due to

A
  • no inflammation in toxic injury
  • numerous mitotic figures
  • Tylenol
24
Q

drugs that are notorious for causing liver problems

A
  • methotrexate
  • tylenol
  • statins
25
Q

most common causes of DILI

A
  • antibiotics

- NSAIDS

26
Q

subclinical DILI often seen with

A
  • statins
  • NSAIDS
  • antibtiocs
27
Q

acute liver injury DILI often seen with

A
  • tyenol

- amoxicillin-clavulanate (augmentin)

28
Q

DILIs from chronic liver injury that may mimic autoimmune disease due to

A
  • minocycline

- NSAIDS

29
Q

DILIs from chronic liver injury that induce NAFLD

A
  • amiodarone

- tamoxifen

30
Q

DILIs from chronic liver injury that lead to fibrosis and cirrhosis

A
  • methotrexate