ALD,NALD,DILD Flashcards Preview

Gastrointestinal > ALD,NALD,DILD > Flashcards

Flashcards in ALD,NALD,DILD Deck (25):
1

what are the three stages of NAFLD?

simple steatosis, non-alcoholic steatohepatitis, and cirrhosis

2

what exists in NASH that makes it different from steatosis?

inflammation

3

what is tricky about NALFD-induced cirrhosis?

fat and inflammation may disappear

4

what is the principle finding in NAFLD?

macrovesicular steatosis

5

what are two theories on progression from steatosis to steatohepatitis (inflammation too)?

lipotoxicity theory (fat can beget inflammation) and 2 hit hypothesis (something else acting on the fat)

6

untimately, ___ is the cause of inflammation in NASH

reactive oxygen species

7

name 3 major histologic features seen in steatohepatitis (identical in non-alcoholic and alcoholic)

1. macrovesicular steatosis, 2. cytologic ballooning, 3. Mallory bodies (eosinophilic concretions)

8

how common is the progression from NASH to cirrhosis, ESLD, and/or HCC?

common; about 20%

9

what is the cure for NASLD that has progressed to cirrhosis?

transplant

10

what are the major risk factors for NAFLD?

obesity, diabetes, inactivity, metabolic dz

11

transaminase levels in NASLD are (low/normal/moderate/high)

moderate (less than 500); ALT>AST

12

algorithm for diagnosing NASLD

repeat LFTs, screening tests, if negative screening and positive for echogenic ultrasound, then good clinical dx for NASLD

13

name 2 non-invasive methods of assessing disease severity in NASLD

transient elastography (sound wave through liver); NAFLD Fibrosis Score followed by risk stratification

14

what are the factors that contribute to NAFLD fibrosis score

age, BMI, diabetes, AST/ALT, platelets, albumin

15

management of NAFLD

vitamin E has promise, but increases cancer risk; DIET AND EXERCISE BEST!

16

describe to chronology of alcoholic liver dz

can be acute or chronic; often co-morbid with other liver dz

17

diagnosis of alcoholic liver dz

AST: ALT ratio 2-3:1 (still not crazy high); can see elevated GGT with normal-ish AP

18

name 4 extrahepatic lab findings in ALD

macrocytosis, folate/B12 deficiency, low BUN, thrombocytopenia

19

how does alcoholic hepatitis (acute from binge/heavy drinking) differ clinically from the chronic form?

low grade fever, leukocytosis, hepatomegaly

20

how to determine severity of acute alcoholic hepatits

equation that factors in prothrombin time and bilirubin

21

tx for alcoholic hepatitis

prednisolone (cheaper) or pentoxifylline (blood viscosity reducer)

22

name 3 drugs notorious for causing liver problems and 2 drugs that cause lots of liver problems bc of high use

methotrexate, tyelnol, statins are notorious; ABX and NSAIDS used so much

23

subclinical DILI occurs with use of ____ (name 2) and results in high ____ which normalize when drugs are withdrawn

statins, NSAIDs; transaminases

24

most common drug causes of acute liver injury

tylenol, augmentin (can be hepatic or cholestatic)

25

chronic DILI may mimic ____ or ___ and ultimately lead to cirrhosis (____)

autoimmune dz (minocycline, NSAIDs), NAFLD (amiodarone), cirrhosis = methotrexate