Hepatic Steatosis

1. What are the common manifestations of alcoholic cirrhosis? Which of these are secondary to

Beside hepatocyte injury and death, inflammation is another histological hallmark of NASH. The inflammation during NASH is described as sterile inflammation as the inflammatory response occurs in the absence of pathogens or external antigens.44 This sterile inflammation may be a consequence of lipid-induced hepatocyte stress, damage, and cell death. Indeed, cell death can trigger an inflammatory response by innate immune cells.6 On the other hand, a sustained inflammatory response may contribute to hepatocellular injury and death, creating a feed-forward loop between tissue injury and inflammation. Inflammation in NASH is most strikingly associated with activation of the innate immune system,

Cirrhosis is the 11th leading cause of death by disease in the United States. Almost one half of these are alcohol related. About 25,000 people die from cirrhosis each year.

This case study is about Abdul Chidiac, a 51 year old male, married with 4 children. He had a medical history of hypertension, hypercholesterolaemia and cirrhosis with two admissions in the last six months. He is a smoker and drinks beer, 5-6 bottles per day. As Carithers & McClain (2010) explained the patient’s medical history is another indicator of the risk for cirrhosis; the progression to cirrhosis is adaptable and may take time over weeks or many years. Cirrhosis is a liver disease characterized by permanent scarring of the

In the presented case scenario, we have Mr. Gil Martin who is a 55-year-old Hispanic male. He comes in to the clinic today with complaints of weakness, fatigue, and loss of appetite. A student nurse will be precepting your assessment of Mr. Martin and when collecting subjective and objective data it is important to pay close detail to all findings. Ultimately this patient was diagnosis with cirrhosis, which is an abnormal liver condition that leads to irreversible scarring of the liver (National Institute of Health [NIH], 2017), so during assessment we should pay attention to details leading to this diagnosis.

I chose an article, “ Large Hepatocellular Carcinoma in an Essentially Asymptomatic Young Woman,” in the Journal of Diagnostic Medical Sonography. This article was chosen because I am familiar with the liver and its structures which made me interested specifically in this article because.of my previous knowledge of the liver and Hepatocellular Carcinoma from previous studies in class.

Giving the fact that NAFLD is usually an asymptomatic disorder, it is often unrecognized in everyday clinical practice. Namely, most patients with NAFLD have no symptoms, and aminotransferase levels which are used as a marker of liver damage, are within normal values in almost half of all patients. NAFLD is strongly associated with type 2 diabetes mellitus (T2DM) and has been linked to increased cardiovascular disease (CVD) risk. It is characterized by insulin resistance and mitochondrial dysfunction6. Indeed, there is a gradual increase in the severity of insulin resistance in the range of NAFLD which may contribute to the evolution of liver damage. Also, it is associated with an increased risk of kidney disease in subjects with multiple CVD

There is a clear need to develop novel biomarkers, which can be used in conjunction with current DILI tests to provide a diagnostic result with a much greater specificity and sensitivity. The development of specific diagnostic biomarkers for DILI would greatly improve patient safety by providing a faster and more accurate DILI diagnosis and an improved monitoring during drug treatment initiation. Such biomarkers would also greatly enhance the preclinical development of drugs, which would indicate hepatotoxicity at a much earlier stage of drug

Alcohol abuse and hepatitis B and C are the most common causes of cirrhosis. Cirrhosis can cause weakness, loss of appetite, jaundice, itching, and fatigue, and can be diagnosed by blood tests, physical examinations, and a liver biopsy. There are many complications of cirrhosis, such as edema and ascites, spontaneous bacterial peritonitis, hepatic encephalopathy, portal vein hypertension, hepatorenal and hepatopulmonary syndrome, hypersplenism, and liver cancer. One of the most common treatments of cirrhosis is a liver transplant. However, alcoholics have to be sober for six months to prove that they are serious about taking care of their new liver and staying sober after the

Fibroscan is one of the most common, accurate and validated alternative method. It is an ultrasound-based imaging technology, which measures liver stiffness. The degree of liver stiffness directly correlates with the degree of fibrosis (Sandrin et al., 2003).It also allows follow up the progression of fibrosis (Foucher et al., 2006).

Additionally, many chronic liver diseases can lead to cirrhosis. For example, nonalcoholic fatty liver disease (NAFLD) can lead to cirrhosis and is associated with obesity, hyperlipidemia, metabolic syndrome and type 2 diabetes mellitus. Hereditary metabolic disorders such as hemochromatosis and Wilson disease can also lead to cirrhosis (McCance & Heuther, 2014). It seems the cause of cirrhosis is multifaceted. Additionally, many diseases can lead to cirrhosis and it is understandable why the etiology of cirrhosis has not been parsed out, especially because the cause can differ from a

Major risk factors for hepatocellular carcinoma include infection with HBV or HCV, alcoholic liver disease, and most probably non-alcoholic fatty liver disease. Less common causes include hereditary hemochromatosis, alpha1-antitrypsin deficiency, autoimmune hepatitis, some porphyrias, and Wilson’s disease, aflatoxin ingestion, exposure to inorganic arsenic through drinking water (Shamseddine et al., 2009). The distribution of these risk factors among patients with hepatocellular carcinoma is highly variable, depending on geographic region and race or ethnic group (El-Serag and Rudolph, 2007). Most of these risk factors lead to the formation and progression of cirrhosis, which is present in 80 to 90% of patients with hepatocellular carcinoma (Chen et al.,2009).

Choice “E” is the best answer. Ultrasonography is the most widely used imaging technique to help diagnose ADPKD. It can detect cysts from 1-1.5 cm. This study avoids the use of radiation or contrast material, is widely available, and is inexpensive. The sensitivity of ultrasonography for ADPKD1 is 99% for at-risk patients older than 20 years; however, false-negative results are more common in younger patients. Sensitivity for ADPKD2 is lower and is still not well defined. Ultrasonography is also useful for exploring abdominal extrarenal features of ADPKD (e.g., liver cysts, pancreatic cysts). The presence of hepatic or pancreatic cysts supports the diagnosis of ADPKD[1].

There are three major classifications of drug induced liver injury that occur as a result of both intrinsic and idiosyncratic hepatotoxicity: Hepatocellular injury, cholestatic injury and mixed hepatostatic and cholestatic injury. Hepatocellular injury, as the name suggest, refers to the injury to the liver cell. Cholestatic injury refers to injury to the biliary system. Mixed hepatocellular and cholestatic injury refers to injury to both the liver cells and the biliary system. Other less common types of DILI include chronic hepatitis, chronic cholestatis, granulomatous hepatitis, fibrosis or cirrhosis, and

Acute liver failure is an unusual but life-threatening critical illness, which arises without preexisting liver disease and always supervenes high mortality. The 30s adults in good condition are main sufferers of acute liver failure. The clinical features commonly include: abnormal liver biochemical values, hepatic dysfunction and coagulopathy. Encephalopathy may also occur with multiorgan failure, which cause 50% of death.