Alcoholic and Nonalcoholic Liver Diseases

These flashcards cover key concepts related to alcoholic and nonalcoholic liver diseases, including stages, histologic features, associated conditions, and specific metabolic processes.

Three stages of alcoholic liver disease

Hepatic steatosis, Alcoholic hepatitis, Alcoholic cirrhosis.

Fully reversible stage of alcoholic liver disease

Hepatic steatosis.

Metabolic change driving alcoholic fatty liver

Increased NADH leads to increased VLDL and triglyceride accumulation.

Four histologic features of alcoholic hepatitis

Ballooned hepatocytes, Mallory bodies, Neutrophilic inflammation, Fibrosis.

AST:ALT ratio suggesting alcoholic liver disease

Typically ≥ 2:1.

Pathologic process leading to cirrhosis in chronic alcohol use

Stellate cell activation with collagen deposition causing bridging fibrosis.

Most common cause of chronic liver disease in the US

Chronic alcohol use.

Three conditions associated with Nonalcoholic Fatty Liver Disease/Nonalcoholic Steatohepatitis (NAFLD/NASH)

Obesity, Type 2 diabetes, Metabolic syndrome.

Histologic triad required to diagnose Nonalcoholic Steatohepatitis

Steatosis, Lobular inflammation, Ballooned hepatocytes.

Metabolic liver disease involving iron overload

Hemochromatosis.

Gene mutation causing hereditary hemochromatosis

HFE mutation (C282Y).

Hormone deficiency causing increased iron absorption in hemochromatosis

Hepcidin deficiency.

Classic clinical tetrad of hemochromatosis

Cirrhosis, Diabetes, Skin hyperpigmentation, Cardiomyopathy.

Stain highlighting iron deposition in liver tissue

Prussian blue.

Metabolic liver disease involving copper accumulation

Wilson disease.

Gene mutated in Wilson disease

ATP7B.

Lab abnormalities typical in Wilson disease

Low ceruloplasmin and increased urinary copper excretion.

Eye finding characteristic of Wilson disease

Kayser–Fleischer rings.

Common neurologic findings in Wilson disease

Movement disorders and psychiatric symptoms.

Metabolic liver disease involving misfolded protein accumulation

Alpha-1 antitrypsin deficiency.

PAS stain finding in alpha-1 antitrypsin deficiency

PAS-positive, diastase-resistant globules in hepatocytes.

Lung disease associated with alpha-1 antitrypsin deficiency

Panacinar emphysema.

Definition of primary biliary cholangitis (PBC)

Autoimmune destruction of small intrahepatic bile ducts.

Autoantibody characteristic of primary biliary cholangitis (PBC)

Antimitochondrial antibody.

Common symptoms of primary biliary cholangitis (PBC)

Pruritus and fatigue.

Histologic lesion typical of primary biliary cholangitis (PBC)

Florid duct lesion.

Definition of primary sclerosing cholangitis (PSC)

Chronic liver disease characterized by strictures and dilation of bile ducts.

Disease associated with primary sclerosing cholangitis (PSC)

Ulcerative colitis.

Imaging finding characteristic of primary sclerosing cholangitis (PSC)

Beading of bile ducts on ERCP/MRCP.

Increased malignancy risk in primary sclerosing cholangitis (PSC)

Cholangiocarcinoma.

Definition of Budd–Chiari syndrome

Hepatic vein thrombosis causing liver congestion.

Conditions predisposing to Budd–Chiari syndrome

Myeloproliferative disorders and hypercoagulable states.

Gross liver appearance in chronic passive congestion

Nutmeg liver.

Veno-occlusive disease; another name

Sinusoidal obstruction syndrome.

Benign liver lesion with a central stellate scar

Focal nodular hyperplasia.

Most common benign liver tumor

Cavernous hemangioma.

Benign liver tumor associated with oral contraceptive use

Hepatic adenoma.

Hepatic adenoma subtype with highest malignant potential

β-catenin–mutated adenoma.

Most common primary malignant liver tumor

Hepatocellular carcinoma (HCC).

Four conditions predisposing to hepatocellular carcinoma (HCC)

Cirrhosis, Chronic HBV, Chronic HCV, Nonalcoholic Steatohepatitis.

Tumor marker associated with hepatocellular carcinoma (HCC)

Alpha-fetoprotein (AFP).

Fibrolamellar variant of hepatocellular carcinoma (HCC) association

Typically occurs in young patients without cirrhosis.

Definition of cholangiocarcinoma

Malignancy of bile duct epithelium.

Parasite exposure increasing cholangiocarcinoma risk

Liver flukes (Clonorchis, Opisthorchis).

Medical term for gallstones

Cholelithiasis.

Two main types of gallstones

Cholesterol stones and pigment stones.

Four major risk factors for cholesterol gallstones

Female sex, Obesity, Estrogen exposure, Gallbladder stasis.

Strawberry gallbladder

Cholesterolosis.

Cause of acute calculous cholecystitis

Obstruction of the cystic duct by a gallstone.

Distinguishment of acalculous cholecystitis

Occurs without stones, often in critically ill patients.

Histologic feature seen in chronic cholecystitis

Rokitansky–Aschoff sinuses.

Gallbladder condition increasing carcinoma risk when calcified

Porcelain gallbladder.

Definition of Charcot triad

Fever, jaundice, right upper quadrant pain.

Most common malignancy of the extrahepatic biliary tract

Gallbladder carcinoma.

Major risk factor in most gallbladder carcinomas

Gallstones.