Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
22 Cards in this Set
- Front
- Back
|
Alcoholic cirrhosis - abstinence helps?
|
yes - one of the few cases where you can do soemthing about it
|
|
|
how much alc to get fibrosis and scarring
|
80 grams a day for 10-20 years.
|
|
|
Other protective factors
|
wine
men drinking wtih meals. not hispanic or native american no HCV (synergistic) no homozygosity for hemochromatosis. not obese no susceptibility genes |
|
|
Pathway of alcohol metab - moderate amt
|
ethanol to acetaldehyde via alc dehydrogenase.
acetaldehyde to acetate via acetaldehydr dehydrogenase |
|
|
pathway of alcohol metab - large amounts
|
ethanol to acetaldehyde via a cytochrome pathway which builds up ROS and damages liver.
this is the "microsomal enzyme oxidation system." |
|
|
Gastric metab of alcohol
|
some Alc dehydrogenase in stomach but women have less of it.
|
|
|
where in liver damage occurs
|
centrilobular zone (3)
|
|
|
Neutrophils
|
release ROS which are pro-inf and fibrogenic. they are increased in alcoholic liver disease.
|
|
|
acetaldehyde
|
localized to pericentral zone and stimulate hepatic collagen synth.
|
|
|
cytokines involves
|
TNF and IL-6
|
|
|
bacterial mech
|
alcohol increases permeability of gut membrane so entertotoxins get into portal circ and LPS is included in that. this attaches to kupfer cells which prod cytokines to activate ito cells which cause fibrosis.
|
|
|
2 pathways
|
more often - fatty liver --> fibrosis --> cirrhosis.
can also get fatty liver -->alcoholic hepatitis --> cirrhosis. alcoholic hepatits is the least common thing. |
|
|
only liver test that may be changes with alcoholic fatty liver
|
GGT
|
|
|
how does fatty liver predict progression to cirrhosis
|
it doesn't
|
|
|
neutrophils on liver histology
|
sign of alcoholic hepatitis.
|
|
|
alcoholic hepatitis
|
neutrophils, ballooning degeneration. mallary's hyaline
|
|
|
clinical pres of alcoholic hep
|
fever, hepatomeg, jaundice, anorexia, ascites.
|
|
|
labs of alcoholic hepatitis
|
AST > ALT.
inc in all alc tests but albumin is down. leukocytosis, thrombocytopenia. |
|
|
scores for px of alcoholic hepatitis
|
modified discriminant function - bad to be above 32
MELD score - >18 is bad. this is to assess need of a liver transplant. |
|
|
alcoholic hep -tx
|
supportive
corticosteroids - only in severe cases. (prednisolone and pentoxifylline) high calorie diet helps a lot as well. |
|
|
alcoholic cirrhosis - tx
|
abstinence.
tx of complications. transplan. |
|
|
most people who drink...
|
dont get one of these 3 diseases
|
