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22 Cards in this Set
- Front
- Back
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NAFLD is a spectrum of dz containing 3 major conditions. What are they?
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1. Simple steatosis (fat in hepatocytes)
2. Non-EtOH steatohepatitis (fat + inflammation) 3. Cirrhosis (diffuse bridging fibrosis; fat and inflammation may DISAPPEAR) |
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What is the principle finding in NAFLD?
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Macrovesicular steatosis (cytoplasm replaced by a large bubble of fat that displaces the nucleus to the edge of the cell)
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There are 2 general theories by which steatosis can progress to steatohepatits. What are they?
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1. Lipotoxicity theory -- Fat can beget inflammation by itself
2. 2-hit hypothesis -- Excess Fe, EtOH, endotoxin (from gut), etc. are metabolized forming free radicals that damage hepatocytes. |
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What are the major histological findings of steatohepatitis?
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LOOKS LIKE CHICKEN WIRE
1. Macrovesicular steatosis 2. Cytologic ballooning 3. MALLORY BODIES (eosinophilic concretions w/in balooned hepatocytes) 4. Scattered lobular inflammation |
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True or False: Progression from NASH to Cirrhosis occurs in 80% of pts.
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False! It occurs in 20% of pts
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What are the cures available for liver failure resulting from the NASH-->Cirrhosis progression?
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liver transplant is the only curative option.
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Briefly discuss the epidemiology of NAFLD.
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It's on the rise!
1. 1/3 of Americans have steatosis 2. u/s data estimates prevalence around 50% 3. Incidence rising in step w/ rates of obesity, DM, and laziness |
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What pattern of LFTs is pathognomonic for NAFLD?
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There isn't one! But in general, ALT > AST and rarely higher than 5x ULN (usually in the 100-200 range)
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What's the gold standard for diagnosing NAFLD?
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Liver bx demonstrating steatosis +/- inflammation and fibrosis
1. Bx not always needed for clinical dx 2. Imaging may suffice if shows fatty infiltrate. |
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How is the dx of NAFLD made?
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Pts have negative screening tests (HBV, HCV, ANA, AMA, ASMA, Fe, etc.) with echogenic U/S
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Besides a liver bx, what non-invasive method is useful for determining severity of NAFLD?
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NAFLD Fibrosis Score which is based on routing blood work.
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What is the cut-off for low vs. high risk of dz severity using the NAFLD Fibrosis Score?
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<= -1.455 --> Low risk
> -1.455 --> High risk |
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How is NAFLD managed?
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DIET & EXERCISE, Diet & Exercise, diet & exercise!!! Vitamin E might be helpful.
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True or False: EtOH liver disease is usually the pts only medical problem?
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False! Often co-morbid w/ HCV, polysubstance abuse, etc.
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Which enzyme on a LFT panel is raised by EtOH?
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GGT
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What does the liver panel look like in a pt w/ EtOH liver dz?
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AST:ALT ratio of 2:1-3:1 (AST rarely exceeds 300-400)
Elevated GGT AP may be normal Extrahepatic labs may show macrocytosis, folate/B12 def, low BUN, thrombocytopenia |
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How do you establish the severity of alcoholic hepatitis?
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By using a discriminant function:
4.6 x (PT-control) + bilirubin |
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What is the cut-off for treatment of alcoholic hepatitis based on the discriminant function and what is the therapy?
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Score > 32 benefit from Rx
Prednisolone 40mg qd x 1 month Pentoxifylline 400mg TID x 1 month (anti-TNFa) |
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What drugs are notorious for causing liver injury?
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1. MTX
2. Tylenol 3. Statins |
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What drugs cause a subclinical DILI? What is the course of the dz?
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statins, NSAIDs, some abx
asymptomatic rise in transaminases that fall when drug removed |
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What drugs are usually implicated in acute DILI (10% of all acute hepatitis)? What's the course of the dz?
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Tylenol, augmentin
May be acute hepatits form (ALT/AST elevated) or cholestatic form (GGT, AP, bili elevated) |
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What drugs are usually implicated in chronic DILI?
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minocycline, NSAIDs (both cause an AI picture); amiodarone and tamoxifen (cause NAFLD picture); MTX (cirrhosis)
Note that all these eventually lead to cirrhosis and scarring |
