Cirrhosis and Alcohol-Related Liver Disease

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Questions and Answers

Which of the following conditions is associated with an increased risk for hepatocellular carcinoma?

Chronic hepatitis (correct)

Hypoglycemia

Fulminant liver failure

Elevated liver enzymes

What is the primary mechanism believed to be involved in Reye syndrome's pathology?

Viral replication

Liver cirrhosis

Excessive alcohol consumption

Mitochondrial damage of hepatocytes (correct)

Which tumor is known to regress upon the cessation of oral contraceptive use?

Hepatocellular carcinoma

Hepatic adenoma (correct)

Cholangiocarcinoma

Metastasis to liver

What is a common source of metastasis to the liver?

Breast carcinoma Signup and view all the answers

Which of the following risk factors is NOT typically associated with hepatic adenoma?

Cirrhosis Signup and view all the answers

What is the primary mediator of fibrosis in cirrhosis?

TGF-β Signup and view all the answers

Which clinical manifestation is associated with portal hypertension resulting from cirrhosis?

Ascites Signup and view all the answers

What characterizes alcoholic hepatitis?

Swollen hepatocytes with Mallory bodies Signup and view all the answers

Which of the following is NOT typically a feature of cirrhosis?

Increased detoxification ability Signup and view all the answers

What type of liver condition can develop in the absence of alcohol exposure?

Nonalcoholic fatty liver disease Signup and view all the answers

What is a common cause of coagulopathy in patients with cirrhosis?

Decreased clotting factor production Signup and view all the answers

What key pathological process is involved in hemochromatosis?

Iron overload leading to free radical generation Signup and view all the answers

What percentage of alcoholics is likely to develop cirrhosis as a complication of chronic liver damage?

10-20% Signup and view all the answers

What is the primary genetic mutation associated with primary hemochromatosis?

C282Y in the HFE gene Signup and view all the answers

Which of the following is NOT a classic manifestation of primary hemochromatosis?

Obstructive jaundice Signup and view all the answers

In Wilson disease, which laboratory finding is indicative of reduced copper transport?

Increased urinary copper Signup and view all the answers

What is a hallmark symptom of Wilson disease that specifically affects the eye?

Kayser-Fleisher rings Signup and view all the answers

Which condition is characterized by an autoimmune attack on intrahepatic bile ducts?

Primary biliary cirrhosis Signup and view all the answers

Primary sclerosing cholangitis is most commonly associated with which gastrointestinal condition?

Ulcerative colitis Signup and view all the answers

What is the primary treatment for Wilson disease?

D-penicillamine Signup and view all the answers

Which finding would be least likely seen on a liver biopsy of a patient with primary hemochromatosis?

Deposit of hydroxyl free radicals Signup and view all the answers

Study Notes

CIRRHOSIS

End-stage liver damage, characterized by fibrosis and regenerative nodules of hepatocytes
Fibrosis is mediated by TGF-β from stellate cells beneath the endothelial cells lining the sinusoids
Clinical features include portal hypertension, leading to:
- Ascites (fluid in the peritoneal cavity)
- Congestive splenomegaly/hypersplenism
- Portosystemic shunts (esophageal varices, hemorrhoids, caput medusae)
- Hepatorenal syndrome (rapidly developing renal failure).
Decreased detoxification can lead to mental status changes, asterixis, and eventually coma
Decreased protein synthesis can cause hypoalbuminemia (with edema) and coagulopathy

Damage to hepatic parenchyma due to alcohol consumption
Common cause of liver disease in the West
Fatty liver: accumulation of fat in hepatocytes; resolves with abstinence
Alcoholic hepatitis: chemical injury to hepatocytes, characterized by swelling, Mallory bodies, necrosis, and inflammation; can result in death
Cirrhosis: a long-term, chronic alcohol-induced liver damage complication (occurs in 10-20% of alcoholics)

NONALCOHOLIC FATTY LIVER DISEASE

Fatty change, hepatitis, or cirrhosis without alcohol exposure
Associated with obesity
Diagnosis of exclusion; ALT > AST

HEMOCHROMATOSIS

Excess body iron leading to tissue deposition (hemosiderosis) and organ damage (hemochromatosis)
Tissue damage is caused by free radicals
Can be due to an autosomal recessive defect in iron absorption (primary) or chronic transfusions (secondary)
Symptoms include cirrhosis, secondary diabetes mellitus, bronze skin and other findings like dilated cardiomyopathy, cardiac arrhythmias, and gonadal dysfunction and laboratory findings like increased ferritin, reduced total iron-binding capacity (TIBC), elevated serum iron and percent saturation

WILSON DISEASE

Autosomal recessive defect in ATP-mediated hepatocyte copper transport
Results in impaired copper transport, leading to copper buildup in hepatocytes, serum, and tissue deposits
Copper-induced tissue damage from hydroxyl free radicals
Presents in childhood, with cirrhosis, neurologic manifestations (behavioral changes, dementia, chorea), and Parkinsonian symptoms and Kayser-Fleischer rings in the cornea
Laboratory features include elevated urinary copper, reduced serum ceruloplasmin, and elevated liver copper
Treatment involves using D-penicillamine (a copper chelator)

PRIMARY BILIARY CIRRHOSIS

Autoimmune granulomatous destruction of intrahepatic bile ducts, affecting mainly women
Associated with other autoimmune diseases
Etiology is unknown (antimitochondrial antibody is present)
Presents with obstructive jaundice; cirrhosis is a late complication.

PRIMARY SCLEROSING CHOLANGITIS

Inflammation and fibrosis of intrahepatic and extrahepatic bile ducts
Periductal fibrosis with an "onion-skin" appearance

REYE SYNDROME

Fulminant liver failure and encephalopathy in children with viral illness associated with aspirin use
Likely caused by mitochondrial damage to hepatocytes
Presents with hypoglycemia, elevated liver enzymes, and nausea with vomiting; progresses to coma and death

HEPATIC ADENOMA

Benign tumor of hepatocytes
Associated with oral contraceptive use
Risk of rupture and intraperitoneal bleeding, especially during pregnancy; tumors are subcapsular and grow with exposure to estrogen.

HEPATOCELLULAR CARCINOMA

Malignant tumor of hepatocytes
Risk factors include chronic hepatitis (e.g., HBV and HCV), cirrhosis (e.g., alcohol, nonalcoholic fatty liver disease, hemochromatosis, Wilson disease, etc), and aflatoxins
Increased risk for Budd-Chiari syndrome (liver infarction due to hepatic vein obstruction)
Tumors are often detected late due to symptoms masked by cirrhosis
Serum tumour marker is alpha-fetoprotein

METASTASIS TO LIVER

More common than primary liver tumors; common sources include colon, pancreas, lung, and breast
Results in multiple nodules in the liver
Clinically detectable as hepatomegaly with a nodular free edge of the liver

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Description

This quiz covers key concepts related to cirrhosis and alcohol-related liver disease. It explores the mechanisms of fibrosis, clinical features, and consequences of liver damage. Test your knowledge on both end-stage liver conditions and their implications on health.