Alcoholic disease of the liver Flashcards
What is classified as low and high risk drinking
High risk drinking:
- Men: >60g/day
- Female: >40g/day
Low risk drinking
- Men: <21 units/week
- Female: <14units/week
Explain the metabolism of ethanol
Alcohol is metabolized in the body mainly by the liver
The brain, pancreas, and stomach also metabolize alcohol.
Within the liver 3 enzyme systems can oxidize ethanol:
- Alcohol dehydrogenase(ADH) =cytosol
- CYP2E1(cytochrome P450E1)= microsomes
- Catalase= Peroxisomes
Product of all 3 reaction is acetaldehyde
What are the effects of acetyldehydes
Impairment of mitochondrial oxidation of fatty acids leading to accumulation of FA & TG
Formation of oxygen-derived free radicles
Depletion of mitochondrial glutathione.
Bind to hepatic macromolecules such as amines and thiols to form adducts which are immunogenic:
- Trigger autoimmune liver damage
- Stimulate hepatocytes to produce collagen
- Impair itracellular transport
What are the risk factor for alcoholic liver disease
Amount and duration of intake
Drinking pattern: continious > binge
Gender: women > men
Genetics
Co-existant chronic viral hepatitis
Nutrition: obesity and malnutrition
What are the spectrum of iver disease
Steatosis: Reversible
Steatohepatitis: Reversible
Chirrhosis: Irreversible
Explain alcoholic fatty liver (steatosis)
Most frequent abnormality
Usually asymptomatic
Occasional symptoms: nausea and RUQ pain
LFT usually normal
Diagnosed with US and biopsy
No treatment just abstinance of alcohol and should dissapear within 4-6weeks
Explain the diagnostic factors of alcoholic hepatits
Jaundice onset within previous 8 weeks
Long term consumption of alcohol
AST>50 U/L
AST/ALT ration >1.5
AST and ALT <400 U/L
Total bilirubin >3mg/dL
Absence of confounding factors
Which are the confounding factors that need to be excluded before diagnosing alcoholic hepatitis
Possible ischeamic disease
Possible metabolic liver disease
Possible drug induced liveer disease
Uncertain alcohol use assessment
Atypical laboratory findings
Which scores are used to determine prognosis of alcoholic hepatitis
Maddery index
Meld score >21
GAHS>9
Lille score is used to assess response to corticosteroids
What is alcoholic liver cirrhosis
Cirrhosis is chronic irreversible injury of hepatocytes characterized by extensive fibrosis and nodular regeneration.
What is the clinical picture of alcoholic liver cirrhosis
Bilateral parotid enlargement
Dupuytren’s contractures
Palmer erythema
Spider angiomatosis
