Lecture 11: Toxic Injury: Alcohol-Induced Disease Flashcards
What is alcohol liver disease?
Alcoholic liver disease (ALD) is a direct result of chronic alcohol abuse affecting the normal functions of the liver and can have many effects depending on the concentration and length of exposure to alcohol.
The end result of the disease, cirrhosis, culminates in a dysfunctional and diffusely scarred liver
Recall the 3 major types of alcohol-induced liver disease.
- fatty liver
- alcoholic hepatitis
- cirrhosis
Recall the acute effects of alcohol in the CNS.
- Central Nervous System
- powerful depressant
- inhibitory control centres depressed - releases excitatory pathways
- cortex first - then the limbic system (emotions - memory)
- cerebellum (motor control)
- lower brain stem (respiration/BP)
Recall the acute effects of alcohol in the liver and stomach.
Recall the risk factors for serious liver damage in heavy drinkers.
Recall the chronic effects of alcohol.
Alcoholism refers to the regular intake of alcohol enough to injure - socially, psychologically, or physically. One effect of chronic intake is metabolic derangement - accumulation of triglyceride in liver, heart, muscle, and kidney
Recall the features of alcohol ingestion by the body.
Recall cellular features of the liver.
Liver has 3 primary lobes with a protective covering (Glisson capsule) harbouring about 100,000 lobules. Primary cells in the liver lobules are hepatocytes (comprise 70-80% of liver mass) which are responsible for adjusting secretion and absorption levels of nutrients.
Hepatocytes have long life spans and can participate in regenerating damaged hepatic tissue.
Recall the function of the liver.
Recall the features of liver lobules.
It comprises of:
- terminal hepatic vein (CV)
- hepatocytes (*)
- sinusoids: gaps between hepatocytes
- portal triad/tract
- hepatic artery (HA)
- portal vein (PV)
- bile duct (BD)
- delicate connective tissue (C)
Recall how the structure of the liver lobules assists in its function.
Recall the following diagram in regards to the anatomy of the portal triad.
Recall proteins tested in a blood test to asses normal liver function.
Recall the metabolism pathway of alcohol in the body.
Recall the routes of alcohol metabolism in cells.
Recall the key morphological features of alcohol-induced liver diseases.
Recall how alcohol alter FA metabolism in the liver.
Describe fatty liver.
Recall the histopathology of alcoholic hepatitis.
Describe alcoholic hepatitis.
- Symptoms:
- fever
- liver tenderness
- jaundice
- Inflammatory disease - caused by cytokines from Kupffer cells *resident macrophages)
- characterised by necrosis of hepatocytes
- Features
- cytoplasmic hyaline inclusions (Mallory bodies - intermediate filament = cytokeratin)
- neutrophil infiltration
- perivenular fibrosis
Describe chronic alcohol liver disease.
_______________ are toxic metabolites of alcohol.
Acetaldehyde adducts
Recall the hyperactivation of pro-inflammatory response and immune cell activation due to chronic ethanol consumption.
Recall the following histopathology and visual features of cirrhosis.
Recall the treatment and prognosis of cirrhosis.
Recall other diseases/complications of ALD.
Describe portal hypertension.
The most common result of alcoholic cirrhosis is a haemodynamic change referred to as portal hypertension. Development of portal hypertension is the earliest and most important complication of cirrhosis.
Portal hypertension is the elevation of the blood pressure within the portal venous system. It develops as a result of the resistance to normal blood flow to the liver via the main portal vein:
- can lead to gastroesophageal varices, found in 65% of patients with advanced cirrhosis
- varices are fragile vessels which can rupture and lead to acute haemorrhage and death in about half of patients
Describe hepatic encephalopathy.
Consequences of Fetal Alcohol Spectrum Disorders.
Recall how the body process xenobiotic compounds.
