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Flashcards in Alcoholic Hepatitis Deck (31)
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What is alcoholic hepatitis caused by?

it is a very common cause of liver injury that is caused by excessive alcohol intake


What feature is associated with alcoholic hepatitis that is not very specific for predicting if the liver will develop cirrhosis?

typically there will be steatosis of the liver 


this is a pathological change in which fat globules begin to accumulate in the cytoplasm of liver cells 


it can be quite harmless, so is not very specific for predicting if the liver will develop cirrhosis 


What is Mallory's hyalin?


What does it suggest if it is present?

it is an aggregate of filament found in the hepatocytes that, if present, indicates a risk of irreversible changes in hepatocytes that may ultimately lead to cirrhosis 


What is Mallory's hyalin a sign of?

Mallory's hyalin (aka Mallory bodies) are not specific for alcoholic liver disease, but is a sign of steatohepatitis 


How is alcohol broken down by the liver?

  • ethanol is oxidised to acetaldehyde


  • acetaldehyde is the converted to acetate by the mitochondria of liver cells 


  • acetate is released into the bloodstream and taken up by peripheral tissues


  • in peripheral tissues it is metabolised to carbon dioxide, fatty acids and water 


Why do some people believe that the gastric mucosa itself is responsible for a lot of alcohol metabolism?

alcohol dehydrogenases are present in many tissues around the body




Why do a lot of alcoholics not lose weight despite severe malnutrition?

alcoholic drinks contain a lot of sugar and calories


What is a cogener?


What types of effects of alcohol do they cause?

  • long-term effects of alcohol are all due to ethanol


  • the short term effects are often due to other alcohols present in the drink, such as isoamyl alcohol


  • these additional alcohols are known as cogeners 


What % of heavy drinkers will develop cirrhosis and fatty liver?

  • 10 - 30% of heavy drinkers will develop cirrhosis


  • 50% of heavy drinkers will have fatty liver 


What nutritional factors are thought to contribute to liver damage?



nutritional factors are controversial, although it is possible that malnutrition and obesity both contribute to liver damage 


What factor alongside alcohol consumption increases the risk of hepatitis?

high alcohol consumption combined with hepatitis C infection greatly increases the risk of hepatitis 


What is the first sign of alcoholic liver disease?


How can this be changed if drinking is stopped?

the first sign is fatty liver 


this occurs in most heavy drinkers at some time, but it is completely reversible upon cessation of alcohol


How is fat metabolism changed during excessive alcohol consumption?


Why does this occur?

  • hepatocytes have to divert resources away from metabolising fats to metabolising alcohol


  • fat metabolism is altered resulting in fat deposits inside the cells 


  • more fats are released into the blood stream as fatty acids


  • there is increased synthesis of triglycerides and fatty acids 


How can acetaldehyde cause damage to the liver?

it binds to liver cell proteins and causes injury to the hepatocytes that leads to inflammation


this inflammation can be a causatory factor in cirrhosis and is likely to cause Mallory's sign


How can alcohol affect collagen synthesis and what can this ultimately lead to?

  • alcohol stimulates collagen synthesis by fibroblasts as well as fibroblast proliferation


  • the fibrosing process ends up linking hepatic veins to portal veins


  • in these places, cell regeneration occurs and nodules form


  • this is the start of the process of cirrhosis


What is shown in this image?

Mallory body


these are eosinophilic inclusions that have a "rope-like" appearance 


What are the clinical signs of alcoholic hepatitis that are related to malnutrition?

  • very thin arms and legs (due to muscle wasting)


  • swollen abdomen


  • red tongue (iron-deficiency anaemia)


  • dry scaly and cracked skin (due to zinc / fatty acid deficiency)


What are the clinical signs of alcoholic hepatitis relating to the endocrine system?

  • gynaecomastia


  • testicular atrophy


  • loss of body hair 


  • signs of "pseudo-Cushing's" - red face, hump, striae 


What are signs of alcohol hepatitis relating to the face/skin?

  • parotid enlargement


  • spider naevi


  • easy bruising 


  • Dupuytren's contracture 


What are neuromuscular signs of alcoholic liver disease?

  • tremor


  • memory loss / cognitive impairment


  • peripheral myopathy (degradation of muscle)


  • epilepsy


  • Wernicke-Korskoff syndrome 


What are the cardiovascular clinical features of alcoholic liver disease?

  • hypertension


  • cardiomyopathy (disease of the heart muscle)


  • hyperdynamic circulation (abnormally increased circulatory volume)


What are the clinical features of alcoholic liver disease affecting the bones?

  • rib fractures may be seen on CXR


  • spinal osteoporosis (particularly in men)


Generally what are the signs of fatty liver?


How does this differ from alcoholic hepatitis?

patients with fatty liver generally have few symptoms


they may notice nausea and malaise and LFTs may be slightly unusual


mild alcoholic hepatitis may be indistinguishable from fatty liver disease (often the 2 co-exist)


What are the symptoms of mild alcoholic hepatitis?

they tend to be more severe than fatty liver:


  • anorexia
  • nausea
  • abdominal pain
  • weight loss


What might be present on examination in someone with fatty liver?

they tend to be asymptomatic but hepatomegaly may be present on examination


What do laboratory tests usually show in fatty liver?

  • laboratory tests are usually normal


  • elevated mean corpuscular volume (MCV) often indicates heavy drinking
    • this is the average volume of a RBC


  • the y-glutamyltansferase (y-GT) level is usually elevated 
    • this indicates that the enzyme is leaking out of hepatocytes and into the blood, suggesting damage to the liver 


What actually is alcoholic hepatitis?


What is happening within the liver?

necrosis of liver cells and infiltration of polymorphonuclear leucocytes


with accumulation of dense cytoplasmic material (called a Mallory body) in hepatocytes


it may progress to cirrhosis, particularly with continued alcohol consumption


What will LFTs and other blood tests show in alcoholic hepatitis?

investigations show leucocytosis with elevated bilirubin and transferases


  • AST and ALT are usually < 500 IU/L
    • higher values suggest hepatitis due to another cause


  • albumin may be low


  • prothrombin time may be prolonged 


What is the treatment for alcoholic hepatitis?

  • treatment is supportive and adequate nutritional intake must be maintained


  • corticosteroids are of benefit in severe disease


What is alcoholic cirrhosis?

  • this is the final stage of liver disease from alcohol abuse 


  • there is destruction and fibrosis, with regenerating nodules producing a classic micronodular cirrhosis 


  • there are usually signs of chronic liver disease