Snapshot A 55-year-old man presents to his primary care physician for an annual examination. He currently does not have any acute complains; however, he continues drinking multiple alcoholic beverages daily. He noticed when he tries to stop drinking alcohol, he becomes tremulous and feels anxious. Laboratory studies demonstrate a transaminitis. An abdominal ultrasound demonstrates hepatic steatosis. Introduction Overview excessive alcohol use can lead to alcoholic fatty liver disease alcoholic hepatitis cirrhosis Pathophysiology ethanol consumption leads to promotion of lipid accumulation within the liver liver cell injury due to increased oxidative stress decreased intake of vitamins ethanol metabolism leads to the production of acetaldehyde reduced nicotinamide adenine Associated conditions malnutrition Wernicke encephalopathy Korsakoff syndrome hepatic encephalopathy Presentation Patients are typically asymptomatic symptoms depend how severe the liver damage is and if the patient developed cirrhosis Symptoms/physical exam palmar erythema gynecomastia testicular atrophy spider angiomas jaundice caput medusae hematemesis or melena Imaging Abdominal ultrasound indication to evaluate liver morphology, which may demonstrate hepatic steatosis or cirrhosis Studies Serum labs aspartate aminotransferase (AST) and alanine aminotransferase (ALT) elevated AST to ALT ratio > 2 γ-glutamyl transpeptidase (GGT) often elevated not specific for alcoholic liver disease macrocytosis suggestive of longstanding disease secondary to decreased vitamin B12 or folate deficiency or alcoholic toxicity Differential Viral hepatitis differentiating factors significantly elevated AST and ALT positive hepatitis testing Treatment Conservative cessation of alcohol indication all patients with alcoholic liver disease associated with improved outcomes nutritional therapy indication vitamin replacement Medical glucocorticoids indication severe alcoholic hepatitis Surgical liver transplantation indication in patients with decompensated liver disease Complications Gastroesophageal varices secondary to portal hypertension Hepatocellular cancer Ascites can result in spontaneous bacterial peritonitis
QUESTIONS 1 of 3 1 2 3 Previous Next Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (M1.GI.13.134) A 39-year-old Caucasian male presents for a physical exam. It is noticed that he has slight hepatomegaly. During the history, the patient states he drinks 7-8 beers daily. Biopsy of the liver is shown in Figure A. What is the primary mechanism for the abnormality seen in Figure A? Tested Concept QID: 101191 FIGURES: A Type & Select Correct Answer 1 Increased production of NAD 16% (18/111) 2 Decreased production of NAD 39% (43/111) 3 Increased fatty acid oxidation 16% (18/111) 4 Increased synthesis and exportation of lipoproteins 7% (8/111) 5 Increased uptake of fat 19% (21/111) M 1 Question Complexity E Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 2 Review tested concept
All Videos (2) Login to View Community Videos Login to View Community Videos Fatty Liver Cont. Gastrointestinal - Alcoholic Liver Disease D 2/16/2015 41 views 5.0 (1) Login to View Community Videos Login to View Community Videos Fatty Liver Gastrointestinal - Alcoholic Liver Disease E 2/16/2015 79 views 0.0 (0)