Icm 3 Alcoholic Liver Disease

Front 1

what injury results from booze

Back 1

Normal--> fatty liver --:>some get hepatitis and some get cirrhosis

**majority of ppl who abuse EtOH DONT get liver injury

Front 2

tell me about EtOH fatty liver

Back 2

asx
enlarged on PE and US
mild ASL ALT elevation

AST: ALT 2:1, in NON EtOH Fatty liver ALT>AST

**non alcoholic fatty liver caused by obesity, massive weight loss, TPN, DM

Front 3

whats AST ALT w/Fatty liver caused by fat? EtOH?

Back 3

FAT: ALT>AST

EtOH: AST>ALT

Front 4

whats alcoholic hepatitis presentation

Back 4

fever, hepatomegaly, jaundice, dark urine, clay stools, hepatic bruit, cirrhosis,

Spider antiomata, palmer erythema, gynecomastia, ascited, hepatic encephalopathy

Front 5

is there cirrhosis in alcoholic hepatits

Back 5

not always

AST>ALT both are mild increase (<200)

Front 6

whats the liver fx test in EtOH hepatitis

Back 6

AST>ALT, not more than 200
GGT increased
Bli Increased

**high mortality, not necessarily cirrhosis

Front 7

what can cause cirrhosis

Back 7

other things besides EtOH
viral- C, B
non alcoholic steatohepatitis, metabolic liver disease, primary sclerosing cholangiits

Front 8

whats the pathogenesis of EtOH cirrhosis

Back 8

EtOH directly impairs oxidation of hepatic fatty acids and accelerates hepatic lipogenesis→fatty acid accumulation and fatty infiltration
Persistent fatty infiltration with associated low-grade fatty acid hepatotoxicity and chronic inflammation →
Early pericentral fibrosis / scarring →
Usually reversible at this stage with abstinence from alcohol
Macronodular fibrosis →
Micronodular fibrosis

Front 9

your chronic EtOH shows up with temporal wasting, spider antiomata, jaundice, firm nodular liver edge and palpable spleen tip, whats the state of their liver

Back 9

cirrhosis

Front 10

what are hte LFT in cirrhosis

Back 10

increased ALT, AST adn GGT

increased conj bili
increased PT (vit K)
can have increased cholesterol

Front 11

what are some complications of cirrhosis

Back 11

1 bleeding
2. portal HTN
3. ascites
3. spontaneous bacterial peritonitis (kids strep pneumonia, adults e coli)

**NO elective surgery!

Front 12

whats the prognosis of cirrhosis

Back 12

50% at 5 years

liver transplant

Front 13

what is teh autoimmune liver disease that affects middle age women

Back 13

primary biliary cirrhosis (PBC)

tired and itchy

Front 14

what is the most common cholestatic liver disease in the US

Back 14

PBC

autoimmune, affects middle age women

ongoing inflammatory destruction of intralobular bile ducts, leads to chronic cholestaiss and cirrhosis

Front 15

who is a tired itchy middle age woman

Back 15

PBC
**RUQ pain, anorexia, jaundice, spider antiomata, mm wasting of temporal mm, ascited, edema, bone disease

Front 16

what is the PE like for a pt with PBC

Back 16

older woman who is tired and itchy

hyperpigmented skin- melanin deposition, xanthomas

hepatosplenomegaly, portal HTN

Front 17

xanthomas and hyperpigmented melanin in skin is classic in what disease

Back 17

PBC

Front 18

what labs are increased in PBC

Back 18

ALK phos
ALT AST (N to high)
AMA
ANA
hyperlipidemia
IgM, ceruloplasmin, bile acids

**GGT NORMAL

Front 19

what is the pattern

ALK phos high
normal to high ALT AST
ANA, AMA
bili Normal but increasing
Hyperlipidemia

Back 19

PBC

Front 20

what is teh course of disease in PBC

Back 20

progress at varied rates

sx in 2-4 years

**liver granuloma is good prognosis

Front 21

is liver grnauloma good or bad in PBC

Back 21

good prognosis

Front 22

what si the tx for PBC

Back 22

ursodeoxycholic acid

**its an autoimmune disease with itchy pigmented lipid deposited skin adn + ANA, AMA

Front 23

whats the def of ACUTE liver failure

Back 23

onset of hepatic encephalopathy less than EIGHT weeks after onset of liver disease in pt w/previously healthy liver

OR

onset of hepatic encephalopathy less than 2 weeks after onset of jaundice in a pt w/previous underlying liver disease

Front 24

whats the most common cause of acute liver failure

Back 24

acetemenophen OD

also can have fulminant Hep B (or A,C)

portal venous thrombosis, ischemic hepatitis

Front 25

what can portal venous thrombosis adn ischemic hepatitis cause, what else causes the same thing

Back 25

ACUTE liver failure

also caused by acetemenophen, hep B or ischemic hepatits

Front 26

what are some complications of acute liver failure

Back 26

1. hepatic encephalopathy: cognitive prblms, confusion, coma,
-NH4 toxicity
- Bile salts are essential for the activation of duodenal enterokinase, which is essential for activation of pancreatic proteases, which are essential for protein absorption from the gut Gut proteins are then catabolized by bacteria, producing NH4

2. Cerebral Edema
3. clotting problems
4. hepato renal syndrome
5. solaracidosis

Front 27

what is the most common cause of death from acute liver disease

Back 27

brainstem herniation bc of cerebral edema

Front 28

what is hepato renal syndrom

Back 28

liver failure induced renal failure

Front 29

in chronic liver failure what do ppl die from

Back 29

GI bleed
complication of ascites
not real renal failure

Front 30

do we get portal HTN with liver failure

Back 30

yep

increased pressure --> esophageal varicies,

Front 31

whats the mech of ascites in liver failure

Back 31

Portal hypertension with reflex splanchnic vasodilator production and reduced total peripheral resistance activate the renin angiotensin system, increasing aldosterone and ADH levels. Hepatic catabolism of aldosterone is already impaired and all of this causes sodium and water retention. Circulatory oncotic pressure drops with impaired hepatic protein synthesis, and fluid “leaks” into the abdomen

Front 32

who gets ascites, whats prognosis

Back 32

most common manifestation of liver decompensation

((poor prognosis

Front 33

tell me about spontaneous bacterial peritonitis

Back 33

happens in cirrhosis sometimes
long term survival is poor
E coli in adults, strep pneumonia in kids

*risks include: low ascites protein, hypotension, instrumentation

Front 34

whats a transjugular intrahepatic portosystemic shunt

Back 34

low resistance channel btwn systemic hepatic vein and intrahepatic portion of portal vein to reduce portal HTN