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Common Alcoholic Liver Disease (ALD) exam questions for medical finals, OSCEs and MRCP PACES


Question 1.

How does alcoholic liver disease present?

  • Three major presentations:
    • Fatty liver:
      • Accumulation of fat inside hepatocytes that can occur after only a few days of drinking heavily
      • Usually asymptomatic and with no signs
    • Alcoholic Hepatitis
      • Inflammation of hepatocytes due to excessive alcohol intake
      • Cases range from mild with only derangement of liver function tests to severe with a high mortality rate.
      • Moderate cases may have mild jaundice, hepatomegaly and signs of chronic liver disease
      • Severe cases may have decreased GCS, encephalopathy, high bilirubin levels and prolonged prothrombin times.
    • Cirrhosis



Question 2.

What is the possible pathogenesis of alcoholic liver disease?

  • ETOH processing in the liver increases the NAD/NADH ratio, which causes more fatty acid synthesis and less fatty acid oxidation, causing fatty liver.
  • Acetaldehyde produced from ETOH may also damage liver cells
  • ETOH might convert normal hepatocytes into myofibroblasts, which lay down collagen and cause fibrosis.
  • ETOH enhances the effects of other toxins on the liver (e.g. paracetamol).