Alcoholic Liver Disease Flashcards

1
Q

How does alcohol cause damage in the liver?

A
  • Alcohol is directly toxic to the liver. Mostly it causes liver failure over chronic exposure, but some people can have acute liver failure due to alcohol
  • It also interrupts a lot of metabolic processes such as gluconeogenesis or lipid metabolism
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2
Q

How does alcohol cause steatosis?

A

Interruption to the lipid metabolism pathway leads to a fatty liver even if your not fat

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3
Q

What is steatohepatitis?

A

A fatty liver causing inflammation
This can lead to fibrosis and eventually cirrhosis

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4
Q

What are NAFLD/NASH?

A

Non-Alcoholic Fatty Liver Disease
Non-Alcoholic Steatohepatitis

Caused by obesity and related diseases e.g. diabetes and hypercholesterolaemia

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5
Q

How do we detect steatohepatitis and treat it?

A

Ultrasound
~maybe a biopsy
Raised ALT

Treat with weight loss, exercise and abstinence if alcohol induced

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6
Q

How do we gain information about alcohol & dependancy from a patient?

A
  • History
  • Use of CAGE questions
  • Fast/Audit questionnaire about alcohol intake/effects
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7
Q

What are hte cage questions?

A

Just a few questions that help determine someones dependance on alcohol:

  • ever felt the need to Cut down
  • Annoyed by criticism of your drinking?
  • Guilty about your drinking?
  • need an Eyeopener? (morning drink)
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8
Q

What are the signs/symptoms of alcohol induced liver disease?

A

Jaundice, muscle wasting and other signs of chronic liver disease
Mostly dont show up until advanced disease

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9
Q

What are the common signs of chronic liver disease?

A

Spider naevi
palmar erythema
gynaecomastia
loss of axillary and pubic hair
ascites
encephalopathy

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10
Q

What are the signs of alcholic liver disease in the lab tests??

A
  • A high AST/ALT ratio is almost always an indicator of alcohol abuse
  • Raised Gamma GT
  • Macrocytosis (Enlarged RBCs)
  • Thrombocytopenia (low platelets)
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11
Q

Macrocytosis?

A

Enlarged RBCs

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12
Q

How does hepatic encephalopathy relate to alcoholsim?

A

A common feature of liver failure, its not alcohol specific but very common in alocholic liver disease

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13
Q

How does hepatic encephalopathy occur?

A

Confusion due to ammonia in the brain
Normally the liver breaks down ammonia to urea.
Something happens to cause a rise in ammonia and the damaged liver fails to keep up causing acute hepatic encephalopathy

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14
Q

What are common causes for ammonia levels rising in the body?

A

= Infection
= Drugs
= Constipation
= GI bleed
= Electrolyte Disturbance

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15
Q

How do constipation and GI bleeds cause a rise in ammonia?

A

Faeces and blood in the gut give off/ break down to ammonia which we reabsorb into the portal circulation

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16
Q

How do we treat hepatic encephalopathy?

A

Treat the cause (antibiotics, laxatives etc)
Supportive:
- ITU
- Airway support
- NG tube for meds

17
Q

How do we grade hepatic encephalopathy?

A

1-4 with:
1 = mild confusion
4 = coma

18
Q

What is spontaneous bacterial peritonitis? (SBP)

A

Infection of the peritoneum, usually with ascites.
Again not exclusive to alcohol but as a result of liver cirrhosis, its very common with chronic alcohol use.

19
Q

What are the symptoms of spontaneous bacterial peritonitis?

A

Abdominal pain
Fever/Rigors
Renal Impairment
Signs of Sepsis e.g. malaise, nausea, vomiting etc
Tachycardic

20
Q

How do investigate spontaneous bacterial peritonitis?

A

Ascitic tap:
- Fluid protein & glucose levels
- Cultures
- Cell count (should show raised neutrophils)

Also exclude any surgical cause for peritonitis

21
Q

How do we treat SBP?

A
  • IV antibiotics
  • Ascitic Fluid Drainage
  • +/- IV albumin infusion (holds fluid in vascular space so asicites doesnt refill on drainage)
22
Q

What is alcoholic hepatitis and what does it cause?

A

Inflammation of the liver due to excess alcohol (usually chronically), often associated with steatosis/steatohepatitis.

IT can cause cirrhosis leading to -> jaundice, encephalopathy, decompensated hepatic function.

23
Q

What does Decompensated hepatic function mean?

A

When liver disease reaches the point that the rest of hte liver can no longer compensate for the damaged parts and problems begin.

24
Q

How do we test for decompensated hepatic function?

A

Low albumin (made in liver)

Raised prothrombin time/ INR. (Liver makes clotting factors)

25
Q

How do we diagnose alcoholic hepatitis?

A
  • Low albumin
  • Raised INR
  • Raised Bilirubin
  • Raise Gamma GT & ALP
  • Alcohol history
  • scan for cancers
26
Q

How do we treat alcoholic hepatitis?

A
  • Treat complications e.g. infection (SBP) & Encephalopathy
  • Stop alcohol & treat withdrawel
  • Steroids (if indicated)
  • Balance nutrition
  • Airway protection/ITU care
  • Supportive Care
  • Protection against GI bleeds
27
Q

When/what are steroids indicated for alcoholic hepatitis?

A

IF Glasgow alcoholic hepatitis scoe >9 or maddreys discriminant function >32.

If score is below either then steroids do more harm than good

Oral Prednisalone

28
Q

How do we balance the nutrition of someone with alcoholic hepatitis?

A

Usually have to increae caloriw intake and arrange a meeting with a dietician.

29
Q

Whats the prognosis for alcoholic hepatitis?

A

40% mortality, 90% in severe cases
Much higher if they keep drinking, also rises with decompensated liver or encephalopathy