non-viral hepatitis Flashcards

(42 cards)

1
Q

what is NAFLD ?

A

non-alcoholic fatty liver disease

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2
Q

what are the requirements for defining NAFLD ?

A
  • evidence of hepatic steatosis either by imaging or histology
    along with lack of secondary causes of hepatic fat accumulation

- lack of secondary cause of hepatic fat accumulation such as significant alcohol consumption

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3
Q

what is defined as significant alcohol consumption ?

A

> 21 drinks for men per week

>14 drinks for women per week

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4
Q

what is the difference between NASH and NAFLD ?

A

NASH - non alcoholic steato-hepatitis where there is inflammation around the fatty tissue
NAFLD - no inflammation

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5
Q

what are the commonly associated abnormalities with NASH?

A
insulin resistance 
metabolic syndrome 
T2DM 
obesity 
dyslipidemia 
hypertension
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6
Q

what is metabolic syndrome ?

A
it is defined as having at least two of the following:
obesity 
Insulin resistance 
dyslipidemia 
hypertension
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7
Q

how does insulin resistance result in the accumulation of triglycerides in hepatocytes ?

A

impaired oxidation of fatty acids
increased synthesis and uptake of fatty acids
decreased hepatic secretion of LDL cholesterol

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8
Q

what happens to fat laden hepatocytes ?

A

they become exposed to free oxygen radicals which causes oxidative stress
causes mitochondrial death
and eventually cell death

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9
Q

what is the presentation of NAFLD like ?

A

usually asymptomatic but may present with vague right upper quadrant pain with elevated transaminases

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10
Q

what may appear upon ultrasound in NAFLD?

A

bright liver

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11
Q

what is the management of NAFLD ?

A

most importantly lifestyle modification

weight loss reduces hepatic steatosis

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12
Q

what medical treatment can be taken for cases of NASH ?

A

Pioglitazone ( improves histology of the patient)

Vitamin E

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13
Q

what surgical treatment may be considered for NAFLD ?

A

bariatric surgery

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14
Q

what are medications that are not recommended for the treatment of NASH ?

A

Metformin
GLp-1 agonists
Omega 3 fatty acids ( non specific for NASH)

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15
Q

what are the treatment options for advanced cases of NASH and NAFLD ?

A

liver transplantation

patients with cirrhosis should be screened for HCC

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16
Q

what is the pathogenesis of primary biliary cholangitis ?

A

chronic inflammatory autoimmune, more common in smokers

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17
Q

if primary biliary cholangitis is left untreated what is the outcome ?

A

end stage biliary cirrhosis

18
Q

what is PBC characterized by ?

A

destruction of intrahepatic bile ducts
portal inflammation
scarring

19
Q

what are the cardinal features of PBC ?

A

non-suppurative destruction of small and medium sized intrahepatic bile ducts

20
Q

what is the onset of PBC ?

A

insidious onset

21
Q

what cann be found in serology in PBC ?

22
Q

what are the AMA directed against ?

A

pyruvate dehydrogenase complex

23
Q

what genetic association is there with PBC ?

24
Q

what is the clinical picture of PBC ?

A
fatigue 
pruritus may precede by jaundice 
scratch marks 
right upper quadrant abdominal discomfort 
jaundice 
bone pain or fractures 
xanthelasma 
mild hepatomegaly 
splenomegaly with the development of portal hypertension
25
what diseases are associated with PBC?
``` Autoimmune hashimotos thyroiditis Sjogren's disease Celiac disease Systemic sclerosis IBD ```
26
what is the pattern of cholestasis in lab results ?
raised ALP raised GGT hyperbilirubinemia
27
when do we consider the cholestasis chronic ?
when it lasts over 6 months
28
what other extrahepatic causes can raise ALP?
Rapid bone growth in children Pagets disease vitamin D deficiency Pregnancy
29
what is the first step in diagnosing PBC ?
abdominal ultrasound to exclude any mechanical obstruction of the bile duct if there is any uncertainty then a liver biopsy may be needed
30
what is the management for PBC?
oral UDCA at 13-15 mg/kg/day
31
what can be given for the pruritus ?
cholestyramine
32
how can we asses osteoporosis inn nPBC patients ?
DEXA scan n
33
what is primary sclerosing cholangitis ?
chronic cholestatic disorder characterized by progressive fibrosis and destruction of extra hepatic and intrahepatic bile ducts of all sizes
34
what is the diagnostic criteria for PSC?
beading and stenosis of the biliary system on cholangiography absence of history of bile duct surgery exclusion of bile duct cancer and is a diagnosis of exclusion
35
what is the clinical picture of PSC?
fatigue intermittent jaundice right upper quadrant abdominal pain pruritus
36
what diseases are associated with PSC ?
Ulcerative colitis
37
what is the most common cause of death in PSC patients ?
cholangiocarcinoma
38
what does the biochemical screening show in PSC?
cholestatic pattern
39
what is the gold standard investigation inn PSC ?
MRCP
40
when can we use ERCP in PSC ?
for therapeutic purposes inn the case of obstruction of a large duct
41
what is the treatment for PSC?
cholestryamine may be used for the pruritus endoscopic therapy | ERCP
42
what is the best predictor of severe fibrosis and disease progression in patients with metabolic syndrome ?
presence of T2DDM obesity