Alcoholic Liver Disease

Question 1

Most important risk factors involved in the devt of alcoholic liver disease

Answer 1

QUANTITY and DURATION of alcohol intake

Question 2

MEN - quantity of ethanol that produces FATTY LIVER

Answer 2

40-80 g/day

Question 3

MEN - quantity of ethanol that produces HEPATITIS or CIRRHOSIS for 10-20 yrs

Answer 3

160 g/day

Question 4

Exhibit increased susceptibility to alcohol liver disease at amt > 20 g/day

Answer 4

WOMEN

safe - 2 drinks per day

Question 5

Infection concurrent w/ alcoholic liver disease associated w/ younger age for severity, more advanced histology and decreased survival

Answer 5

Hepatitis C

Question 6

Gene associated with ALCOHOLIC CIRRHOSIS

Answer 6

Patatin like phospholipase domain containing protein 3 (PNPLA3)

Question 7

Important comorbidity in the progression of alcoholic liver disease to cirrhosis in chronic drinker

Answer 7

Chronic Infection with Hepatitis C virus

Question 8

The Initial and MC histologic response to hepatotoxic stimuli

Answer 8

FATTY LIVER

Question 9

Hallmark of Alcoholic Hepatitis

Answer 9

HEPATOCYTE INJURY

ballooning degeneration
spotty necrosis
polymorphonuclear infiltrate
fibrosis - perivenular and perisinusoidal space of Disse

Question 10

Precursor to the devt of cirrhosis

Answer 10

ALCOHOLIC HEPATITIS

Question 11

Often the only clinical finding in FATTY LIVER

Answer 11

HEPATOMEGALY

RUQ pain
nausea
jaundice (rare)

Question 12

Clinical Manifestations Alcoholic Hepatitis

Answer 12

fever
spider nevi
jaundice
abdominal pain

Question 13

Alcoholic cirrhosis clinical features

Answer 13

RUQ pain
fever
nausea and vomiting
diarrhea
anorexia
malaise

MORE SPECIFIC COMPLICATIONS
ascites
edema
upper GI hemorrhage

PALMAR ERYTHEMA
SPIDER ANGIOMAS
DUPUYTREN CONTRACTURES
DECREASED BODY HAIR
TESTICULAR ATROPHY
GYNECOMASTIA

Question 14

AST (SGOT)

Answer 14

INC 2 to 7 fold, < 400 IU/L, GREATER than ALT

Question 15

ALT (SGPT)

Answer 15

INC 2 to 7fold, < 400 IU/L

Question 16

AST/ALT ratio

Answer 16

> 1

Question 17

Common laboratory findings in ADVANCED LIVER INJURY

Answer 17

Hypoalbuminemia

Coagulopathy

Question 18

Useful in detecting FATTY INFILTRATION of the liver and determining liver size

Answer 18

Ultrasonography

Question 19

Heralds SEVERE ALCOHOLIC HEPATITIS

Answer 19

coagulopathy (PT > 5 s)
anemia
serum albumin < 25 g/L
serum bilirubin > 137 mmol
renal failure
ascites

Question 20

MELD score associated with significant mortality in alcoholic hepatitis

Answer 20

Model for End Stage Liver Disease (MELD > 21)

Question 21

The cornerstone in the treatment of alcoholic liver disease

Answer 21

Complete abstinence from alcohol

Question 22

FDA approved medications for alcohol dependence

Answer 22

Disulfiram
Acamprosate
Naltrexone

Question 23

Glucocorticoids - extensively evaluated in the treatment of alcoholic hepatitis

Answer 23

PREDNISONE - 40 mg / day
PREDNISOLONE - 32 mg/ day

4 weeks followed by a steroid taper

Question 24

Glucocorticoids - extensively evaluated in the treatment of alcoholic hepatitis

Answer 24

PREDNISONE - 40 mg / day
PREDNISOLONE - 32 mg/ day

4 weeks followed by a steroid taper

Question 25

Nonspecific TNF inhibitor - for SEVERE alcoholic hepatitis

Answer 25

Pentoxifylline

Question 26

Accepted indication for treatment in select patients with complications of cirrhosis secondary to alcohol abuse

Answer 26

Liver Transplantation

Question 27

Can occur as a consequence of the overlapping injurious processes secondary to alcohol and HCV infection

Answer 27

Increased liver iron stores | Porphyria Cutanea Tarda

Question 28

Secondary to effects on sterol regulatory transcription factor and peroxisome proliferator activated receptor a (PPAR- a)

Answer 28

steatosis from lipogenesis fatty acid synthesis depression of FA oxidation

Question 29

Intestinal derived endotoxin initiates a pathogenic process through

Answer 29

toll like receptor 4 tumor necrosis factor a (TNF a) -- facilitates hepatocyte apoptosis and necrosis

Question 30

Activate INNATE and ADAPTIVE immunity pathways releasing proinflammatory cytokines ( TNF a), chemokines, and proliferation of T and B cells

Answer 30

Ethanol and its metabolites

Question 31

Pathologic features that may be associated with progressive liver injury

Answer 31

giant mitochondria perivenular fibrosis macrovesicular fat

Question 32

Often present in florid cases but are NEITHER SPECIFIC NOR NECESSARY to establish the diagnosis

Answer 32

Mallory Denk Bodies

Question 33

PRECURSOR to the devt of CIRRHOSIS

Answer 33

Alcoholic hepatitis

Question 34

Present in up to 50% of patients with biopsy proven alcoholic hepatitis

Answer 34

Cirrhosis

Question 35

Typical lab abnormalities (nonspecific) seen in FATTY LIVER

Answer 35

modest elevations of AST, ALT and gamma glutamyl transpeptidase (GGTP) hypertriglyceridemia hyperbilirubinemia

Question 36

Findings that indicate SERIOUS LIVER INJURY with LESS POTENTIAL for complete reversal

Answer 36

ultrasound of portal vein flow reversal ascites intraabdominal venous collaterals

Question 37

Severe alcoholic hepatitis defined as

Answer 37

discriminant function > 32 | MELD > 20

Question 38

EXCLUSION CRITERIA

Answer 38

active GI bleeding renal failure pancreatitis

Question 39

Uses pretreatment variables plus the change in total bilirubin at day 7 of glucocorticoids to identify those patients unresponsive to therapy

Answer 39

LILLE SCORE > 0.45