Flashcards in Fatty Liver Disease Deck (21):
What are risk factors for alcoholic liver disease? (4)
Alcohol (6-8 drinks/day for men; 3-4 for women)
Predisposing factors for alcoholism
Describe how alcohol leads to fatty liver
Increase in NADH increases fatty acid synthesis and decreases B oxidation.
Accumulation of fatty acids in hepatocyte cytoplasm leads to esterification and storage as triglycerides==>fatty liver
What are mechanisms of alcohol-caused liver damage? (3)
Kipper cell activation==>Cytokine production
How does alcohol cause fibrosis?
Activation of stellate cells via:
Products of lipid peroxidation
Describe presentation of fatty liver: symptoms, lab values, histology
Asymptomatic or mild vague symptoms (fatigue, malaise, anorexia, abd discomfort)
Mild to moderate elevated AST/ALT
Histology: macrovesicular steatosis
Describe outcomes of fatty liver
Entirely reversible if you discontinue EtOH
If continue to drink heavily, 20-30% progress to alcoholic hepatitis/cirrhosis
What are clinical symptoms of alcoholic hepatitis?
Occurs after years of heavy drinking
Weakness, anorexia, weight loss, nausea, vomiting
Severe: portal hypertension (varices, ascites, HE)
Describe the physical exam (5) and lab findings (3) of alcoholic hepatitis
Physical exam: jaundice, splenomegaly, palmar arrhythmia, asterixis, ascites
Lab: Elevated AST/ALT (AST more), increased prothrombin time, increased bilirubin
Describe histological findings of alcoholic hepatitis (5)
Centrilobular hepatocyte swelling
What is the Maddrey Discriminant Function?
Measures risk of death in alcoholics:
MDF= 4.6 (PT time of patient- control PT time) + [BR]
Survival based on whether pt can stop EtOH
What are management options for alcoholic hepatitis? (4)
Severe disease: steroids/pentoxifylline
Treatment for infection
What is the treatment for alcoholic cirrhosis? (3) How does it affect prognosis?
Stop EtOH, manage complications of cirrhosis, OLT
If abstain, prognosis good (>50% survival even for decompensated cirrhosis)
If continue to drink, worse prognosis (
What is the spectrum of disease that is encompassed by NAFLD?
Describe the prevalence of NAFLD: overall and among obese patients
Obese patients: 57-74%
How is NAFLD defined?
Fat infiltration in liver exceeds 5-10% by weight
What are risk factors for NAFLD? (4)
What is metabolic syndrome? How is it defined?
3 of 5 criteria:
Low HDL cholesterol
Elevated fasting plasma glucose
What two factors are involved in the hypothesis for development of steatohepatitis from steatosis?
Insulin resistance==> increased lipolysis, hyperinsulinemia==>increased storage of fat in liver
oxidative stress on hepatocytes
Describe the key difference in NASH vs. alcoholic liver disease
Alcoholic liver disease: more men, no DM/obesity, highly symptomatic, high AST
NASH: more common in women, associated with obesity/DM, rarely symptomatic and has normal AST:ALT ratio
What is treatment for NAFLD? (4)
Correction of central obesity
Manage complications of cirrhosis/transplant for advanced disease