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Flashcards in Fatty Liver Disease Deck (21):
1

What are risk factors for alcoholic liver disease? (4)

Alcohol (6-8 drinks/day for men; 3-4 for women)
Predisposing factors for alcoholism
Diet/nutrition
HepB/C

2

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

3

What are mechanisms of alcohol-caused liver damage? (3)

Oxidative stress
Lipid peroxidation
Kipper cell activation==>Cytokine production

4

How does alcohol cause fibrosis?

Activation of stellate cells via:
Acetaldehyde
O2 radicals
Products of lipid peroxidation
TGF-ß

5

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

6

Describe outcomes of fatty liver

Entirely reversible if you discontinue EtOH

If continue to drink heavily, 20-30% progress to alcoholic hepatitis/cirrhosis

7

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)

8

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

9

Describe histological findings of alcoholic hepatitis (5)

Macrovesicular steatosis
PMN infiltrate
Centrilobular hepatocyte swelling
Ballooning degeneration
Mallory bodies

10

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

11

What are management options for alcoholic hepatitis? (4)

Stop EtOH
Severe disease: steroids/pentoxifylline
Nutrition
Treatment for infection

12

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 (

13

What is the spectrum of disease that is encompassed by NAFLD?

Steatosis
NASH
Cirrhosis

14

Describe the prevalence of NAFLD: overall and among obese patients

Overall prevalence=20-30%
Obese patients: 57-74%

15

How is NAFLD defined?

Fat infiltration in liver exceeds 5-10% by weight

16

What are risk factors for NAFLD? (4)

Obesity
Hyperglycemia
T2DM
Hypertriglyceridemia

17

What is metabolic syndrome? How is it defined?

3 of 5 criteria:
Abdominal obesity
Elevated triglycerides
Low HDL cholesterol
Elevated BP
Elevated fasting plasma glucose

18

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

19

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

20

What is treatment for NAFLD? (4)

Weight reduction
Correction of central obesity
Insulin-sensitizing agents/antioxidants?
Manage complications of cirrhosis/transplant for advanced disease

21

What are other causes of fatty liver disease? (6)

Disorders of lipid metabolism
TPN
Wilson's disease
Severe weight loss (i.e gastric bypass)
Medications: steroids, HAART
Toxic exposure