3. Alcoholic Liver Disease (inc hepatitis & cirrhosis briefly) Flashcards
Alcoholic liver disease Abdo pain in relation to liver diseases Cirrhosis (40 cards)
What actually is one unit of alcohol and how long does it take for the body to process one unit
1 unit = 10ml or 8g of pure alcohol and it takes around 1 hour to process
What are the recommendations on alcohol consumption and what does the term 13% ABV mean
limit is 14 units a week best spread over 3 or more days
13 ABV means 13% pure alcohol by volume
Heavy drinkers who suddenly stop drinking usually suffer from what medical term
delirium tremens
What is delirium tremens and why is it so dangerous
acute confusional state which left untreated results in seizures and even death
Under what circumstances should a heavy drinker be admitted to hospital
if they are having acute alcohol withdrawal plus a high risk of developing alcohol withdrawal seizures or delirium tremens
what is the treatment options for acute alcohol withdrawal and delirium tremens
acute alcohol withdrawal - consider benzodiazepines such as librium or carbamazepine ( can offer clomethiazole but with caution)
management of delirium tremens should be with oral lorazepam (if they decline offer parenteral or haloperidol)
There is a progression of alcoholic liver disease;
- Alcohol related fatty liver
- Alcoholic hepatitis
- Cirrhosis
Q: why does alcohol related fatty liver occur
Drinking leads to a build-up of fat in the liver. If drinking stops this process reverses in around 2 weeks.
There is a progression of alcoholic liver disease;
- Alcohol related fatty liver
- Alcoholic hepatitis
- Cirrhosis
Q: why does alcohol lead to alcoholic hepatitis
Drinking alcohol over a long period causes inflammation in the liver sites.
Binge drinking is associated with the same effect.
Mild alcoholic hepatitis is usually reversible with permanent abstinence
There is a progression of alcoholic liver disease;
- Alcohol related fatty liver
- Alcoholic hepatitis
- Cirrhosis
Q: what is cirrhosis in relation to drinking
where the liver is made up of scar tissue rather than healthy liver tissue
this is irreversible
stopping drinking can prevent further damage
The CAGE questionnaire is used in clinical practice to screen for harmful alcohol use, what does CAGE stand for
C – CUT DOWN? Ever thought you should?
A – ANNOYED? Do you get annoyed at others commenting on your drinking?
G – GUILTY? Ever feel guilty about drinking?
E – EYE OPENER? Ever drink in the morning to help your hangover/nerves?
What are the most common complications of alcohol
Alcoholic Liver Disease
Cirrhosis and the complications of cirrhosis including hepatocellular carcinoma
Alcohol Dependence and Withdrawal
Wernicke-Korsakoff Syndrome (WKS) - caused by lack of vitamin B (ie thiamine)
Pancreatitis
Alcoholic Cardiomyopathy
Name some signs of Liver disease
Jaundice Hepatomegaly Spider Naevi- across the body Palmar Erythema - reddening of the hands Gynaecomastia Bruising – due to abnormal clotting Ascites- fluid build up Caput Medusae – engorged superficial epigastric veins Asterixis – “flapping tremor” in decompensated liver disease
What is the general management of excessive alcohol drinking
- Stop drinking alcohol permanently
- Consider a detoxication regime
- Nutritional support with vitamins (particularly thiamine) and a high protein diet
- Steroids improve short term outcomes (over 1 month) in severe alcoholic hepatitis but infection and GI bleeding need to be treated first and do not improve outcomes over the long term
- Treat complications of cirrhosis (portal hypertension, varices, ascites and hepatic encephalopathy)
- Referral for liver transplant in severe disease however they must abstain from alcohol for 3 months prior to referral
Alcohol withdrawal; what signs and symptoms occur at the following time intervals when someone who is alcohol dependant stops drinking; 6-12 hours 12-24 hours 24-48 hours 24-72 hours
6-12 hours: tremor, sweating, headache, craving and anxiety
12-24 hours: hallucinations
24-48 hours: seizures
24-72 hours: “delerium tremens”
Delirium tremens is a medical emergency as alcohol stimulates GABA receptors and down-regulated glutamate receptors which means in chronic alcohol use this imbalance doesn’t level out. What does this present as
Acute confusion Severe agitation Delusions and hallucinations Tremor Tachycardia Hypertension Hyperthermia Ataxia (difficulties with coordinated movements) Arrhythmias
How can you manage/treat alcohol withdrawal
the CIWA-Ar (clinical institute withdrawal assessment) tool to score the patient and guide treatment
chlordiaepoxide (librium) which is a benzodiazepine for 5-7 days
IV high dose B vitamins (pabrinex) which should be followed by regular lower dose oral thiamine
Alcohol excess leads to what vitamin deficiency and in extreme cases what condition does this deficiency cause
thiamine aka vitamin B1
can lead to wernickes encephalopathy
Thinking about differentials to abdo pain:
If the patient has enlarged liver what does it suggest
Its a sign of liver disease
Thinking about differentials to abdo pain:
the absence of what clinical features make it less likely that the patient has underlying chronic liver disease or cirrhosis
Absence of things like spider naevi, palmar erythema, portal hypertension, leukonychia, caput medusa (engorged veins around the umbilicus)
Thinking about differentials to abdo pain:
in the absence of signs of chronic liver disease or cirrhosis what does jaundice + abdo pain lead to you thinking someone may have
acute liver failure or hepatitis
Thinking about differentials to abdo pain:
if the patient doesn’t have a temperature aka isn’t febrile, what is the abdo pain less likely to be caused by
an infection eg viral hepatitis
or the underlying cause is complicated by an infection
Thinking about differentials to jaundice and abdo pain:
If the blood results showed that the rise in ALT/AST is greater than the rise in alkaline phosphatase what does it lead you to think the cause of the jaundice is
a) hepatoceullar damage
b) obstructive cause
hepatoceullar damage
Thinking about differentials to jaundice and abdo pain:
If the blood results showed that the rise in alkaline phosphatase is greater than the rise in ALT/AST what does it lead you to think the cause of the jaundice is
a) hepatoceullar damage
b) obstructive cause
obstructive cause
Define Hepatitis
This means liver inflammation ( and not necessarily infection)
