Gastro - Alcohol-Related Liver Disease Flashcards

1
Q

What is the stepwise progression of alcohol-related liver disease?

A
  1. Alcoholic fatty liver (hepatic steatosis)
    - Drinking causes fat build-up
    - Reversible with abstinence
  2. Alcoholic hepatitis
    - Drinking alcohol over a long period causes inflammation in liver cells
    - Usually reversible with permanent abstinence
  3. Cirrhosis
    - Hepatocytes replaced with scar tissue
    - Irreversible
    - Continued alcohol consumption has very poor prognosis
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2
Q

What is the recommended alcohol consumption?

A

14 units per week

Spread evenly over 3 or more days

Not more than 5 units in a day

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3
Q

What is binge drinking defined as?

A

6 or more units for women
8 or more units for men

In a single session

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4
Q

What does alcohol in early pregnancy lead to?

A

Miscarriage
Small for dates
Preterm delivery
Foetal alcohol syndrome

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5
Q

What are the complications of alcohol?

A

Alcohol related liver disease
Cirrhosis
Alcohol dependence and withdrawal
Wernicke-Korsakoff syndrome
Pancreatitis
Alcoholic cardiomyopathy
Alcoholic myopathy with proximal muscle wasting and weakness
Increased cardiovascular disease risk
Increased risk of cancer - breast and throat

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6
Q

What are the examination findings with excess alcohol?

A

Alcohol smell
Slurred speech
Bloodshot eyes
Dilated capillaries on face (telangiectasia)
Tremor

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7
Q

What blood test results suggest alcohol-related liver disease?

A
  • Raised MCV
  • Raised AST:ALT ratio, over 1.5
  • Raised gamma-glutamyl transferase
  • Raised ALP (later in disease)
  • Raised bilirubin
  • Low albumin
  • Increased prothrombin time
  • Deranged U&Es
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8
Q

What investigations can be used for alcohol-related liver disease?

A
  • Liver ultrasound, may show early fatty changes with “increased echogenicity
  • Transient elastography
  • Endoscopy
  • CT and MRI scans
  • Liver biopsy
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9
Q

How is alcoholic-related liver disease managed?

A

STOP DRINKING
- Psychological interventions
- Detoxication regime
- Nutritional support with vitamins (thiamine and B1), high-protein diet
- Corticosteroids in severe alcoholic hepatitis
- Treat complications
- Liver transplant

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10
Q

What is alcohol dependence?

A

Daily alcohol consumption, strong urges and cravings, difficulty controlling consumption, tolerance to effects of alcohol
Withdrawal when stopping

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11
Q

What are CAGE questions?

A

Used to quickly screen for harmful alcohol use:

C Cut down? Do you ever think you should cut it down?
A Annoyed? Do you get annoyed at others commenting on your drinking?
G Guilty? Do you ever feel guilty about drinking?
E Eye opener? Do you ever drink in the morning to help your hangover or nerves?

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12
Q

What is the AUDIT Questionnaire?

A

Alcohol Use Disorders Identification Test

10 questions, score of 8 or more is harmful use

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13
Q

What symptoms can occur at different times in alcohol withdrawal?

A

6-12 hours
Tremor
Sweating
Headache
Craving
Anxiety

12-24 hours
Hallucinations

24-48 hours
Seizures

24-72 hours
Delirium tremens

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14
Q

What is delirium tremens?

A

Medical emergency associated with alcohol withdrawal

35% mortality if untreated

Extreme excitability of brain and excessive adrenergic activity

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15
Q

What is the pathophysiology of delirium tremens?

A

Alcohol is a depressant substance

Stimulates GABA receptors (inhibitory receptor)

Inhibits glutamate receptors (excitatory)

Causes relaxing effect on brain activity

Chronic alcohol use causes GABA downregulation and up-regulation of glutamate receptors

When alcohol is removed GABA under-function and glutamate over-functions causing extreme excitability and excessive adrenergic activity

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16
Q

How does delirium tremens present?

A

Acute confusion
Severe agitation
Delusions and hallucinations
Tremor
Tachycardia
Hypertension
Hyperthermia
Ataxia
Arrhythmias

17
Q

What scoring tool is used for alcohol withdrawal managed?

A

CIWA-Ar
Used to score withdrawal symptoms and guide treatment

18
Q

What is given to patients with alcohol withdrawal?

A

First line
Chlordiazepoxide (librium)

Second line
Diazepam

High-dose B vitamins (pabrinex)
Followed by long-term oral thiamine to prevent Wernicke-Korsakoff syndrome

19
Q

What is Wernicke-Korsakoff Syndrome?

A

Medical emergency with high mortality rate

Often irreversible and affects the brain

20
Q

What is the pathophysiology Wernicke-Korsakoff syndrome?

A

Alcohol excess leads to B1 deficiency (thiamine)

Thiamine poorly absorbed in persence alcohol

Alcoholics have poor diets and get many of their calories from alcohol

Thiamine deficiency leads to Wernicke’s encephalopathy and Korsakoff syndrome

21
Q

What are the features Wernicke’s encephalopathy?

A

Confusion
Oculomotor disturbances
Ataxia

22
Q

What are the features of Korsakoff syndrome?

A

Memory impairment (retrograde and anterograde)
Behavioural changes