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1

Week 205 - Alcoholism and Hepatitis: What is the metabolism pathway for alcohol?

• Ethanol is converted to Acetaldehyde - (Enzyme ADH)
• Acetaldehyde is converted into acetate - (Enzyme ALDH and reduction of NAD+ to NADH)

2

Week 205 - Alcoholism and Hepatitis: What are the risk factors for liver disease?

• Alcohol consumption
• Genetics, women>men + ethnicity
• BMI
• Diabetes
• Immune factors

3

Week 205 - Alcoholism and Hepatitis: What are the three degrees of alcoholic liver disease?

• Fatty liver
• Alcoholic hepatitis
• Hepatic fibrosis or cirrhosis.

4

Week 205 - Alcoholism and Hepatitis: What is the process of fatty deposition in the space of Disse in fatty liver disease?

• Decreased NAD+ (From increased use during alcohol metabolism)
• This results in decreased gluconeogenesis which results in an increase in fatty acids.

5

Week 205 - Alcoholism and Hepatitis: In which potential space are fatty acids deposited in the liver due to over consumption of alcohol?

Space of Disse, this is between hepatocytes and sinusoids.

6

Week 205 - Alcoholism and Hepatitis: What percentage of fatty livers develop into cirrhosis?

5-15%

7

Week 205 - Alcoholism and Hepatitis: What is the cause of alcoholic hepatitis?

This is from the toxic effect of acetaldehyde.

8

Week 205 - Alcoholism and Hepatitis: What are the signs and symptoms of alcoholic hepatitis?

Change in appetite, tiredness, weakness, fever, hepatomegaly, right upper quadrant pain, jaundice, nausea and vomitting.

9

Week 205 - Alcoholism and Hepatitis: What is the pathology of cirrhosis?

Inflammation and fibrosis that results in necrosis and tissue scarring.

10

Week 205 - Alcoholism and Hepatitis: What is the presentation of cirrhosis?

• S/S of alcoholic hepatitis - change in appetite, tiredness, weakness, fever, hepatomegaly, right upper quadrant pain, jaundice, nausea and vomiting.
• PLUS - oedema, ascites, bruising/bleeding, haematemesis, malaena.

11

Week 205 - Alcoholism and Hepatitis: What are the percentage risk of alcoholics developing the triad of alcoholic liver disease?

• Fatty liver - 90%
• Alcoholic hepatitis - 10-35%
• Cirrhosis - 10-20%

12

Week 205 - Alcoholism and Hepatitis: What is the infective agent for hepatitis C?

• Hepatitis C Virus (HVC)
• A member of the Flaviviridae family.

13

Week 205 - Alcoholism and Hepatitis: Hepatitis C is commonly asymptomatic, but how can it present?

• Malaise
• Anorexia
• Weakness

14

Week 205 - Alcoholism and Hepatitis: What is the standard treatment for Hepatitis C?

• Ribivarin and Interferon.

15

Week 205 - Alcoholism and Hepatitis: Aside from alcoholic liver disease and Hepatitis C what is the other major cause of chronic liver disease?

Obesity

16

Week 205 - Alcoholism and Hepatitis: What are the routes of transmission for Hepatitis A-E

• Oral-faecal - A + E
• Parenteral - B + C (D in the presence of active B)

17

Week 205 - Alcoholism and Hepatitis: What is the prodrome of viral hepatitis?

Flu-like symptoms; anorexia, nausea and vomitting, fatigue, malaise, low-grade fever, myalgia and mild headache.

18

Week 205 - Alcoholism and Hepatitis: What are the signs of symptoms of viral hepatitis during the icteric phase?

Dark urine, pale stools, jaundice, abdominal pain, itch, arthralgia and skin rash.

19

Week 205 - Alcoholism and Hepatitis: Aside from Hep A-EE what other organisms can cause viral hepatitis?

Adenovirus, EBV, CMV, Herpes simplex

20

Week 205 - Alcoholism and Hepatitis: What is the management for viral hepatitis?

• Prevention - Vaccination A,B and E
• Post-exposure prophylaxis - HBIG for Hep. B
• Acute illness - supportive care, anti-viral B +C
• Chronic illness - anti-viral B + C

21

Week 205 - Alcoholism and Hepatitis: What is the geographic distribution of hepatitis E?

Roughly equatorial with china.

22

Week 205 - Alcoholism and Hepatitis: What are the clinical features of HEV?

• Cholestasis, jaundice, malaise, anorexia, nausea, vomitting, abdominal pain, fever, hepatomegaly.
• Less common features include diarrhoea, arthritis, pruritus, urticarial rash.

23

Week 205 - Alcoholism and Hepatitis: Hepatitis B can be found world wide, but in which areas of the world are suffering from an endemic?

• Sub-saharan africa
• China, Kazakstan, Mongolia
• Indonesia

24

Week 205 - Alcoholism and Hepatitis: What are the aims of HBV treatment?

• Loss of viral replication
• Normalisation of transaminases
• Improvement in liver histology
• Loss of e antigen
• Loss of surface antigen

25

Week 205 - Alcoholism and Hepatitis: What is the medical treatment of HBV?

• Peginterferon

• Entecavir
• Tenofovir

• Lamivudine
• Adefovir
• Telbivudine

26

Week 205 - Alcoholism and Hepatitis: What is the natural history of HCV infection?

• Exposure - 15% resolve, 85% become chronic
• Chronic - 80% stable, 20% develop cirrhosis
• Cirrhosis - 75% slowly progressive, 25% death/transplant

27

Week 205 - Alcoholism and Hepatitis: Interferon is used for the treatment of hepatitis, but is frequently in-tolerated due to its side effects, what are they?

Flu-like symptoms, injection site reactions, myalgia and arthralgia, neuropsychiatric, bone marrow suppression, thyroid dysfunction, exacerbation of auto-immune disease.

28

Week 205 - Alcoholism and Hepatitis: What are the adverse effects of Ribavirin?

Teratogenic, haemolytic anaemia, skin rash, cough, insomnia.

29

Week 205 - Alcoholism and Hepatitis: What are the functions of the liver? (5)

• Storing glycogen
• Production of clotting factors
• Processing medication
• Helping to remove toxins from the body
• Production of bile

30

Week 205 - Alcoholism and Hepatitis: What are the principle reactions of drug metabolism in the liver?

• Most drugs are lipid soluble, these are broken down during phase one reactions into products of oxidation, reduction or hydrolysis.
• Phase II reactions then couple these products with endogenous substrates to form water soluble metabolites.