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Alimentary System: Pathology SA > Alcohol Related Liver Disease > Flashcards

Alcohol Related Liver Disease Flashcards

1
Q

What affect does alcohol have on the Liver

A

Affect liver metabolism

Leading to toxicity

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2
Q

What is the breakdown of of alcohol is the liver

A

Ethanol is broken down by alcohol dehydrogenase to acetaldehyde and accetate

with the help of carrier molecule NAD+ –> NADH

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3
Q

What three metabolic pathways does alcohol affect

A

Gluogneogenesis

Lipogenesis

Citric acid cycle

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4
Q

What affect does alcohol have on gluocogeneiss

A

Prevents build up of glycogen reserve - can present hypoglycaemic

Build up of pyruvic acid - present acidosis

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5
Q

What affect does alcohol have on the lipogenesis

A

Interrupts lipid metabolism pathway

resulting in excess lipids

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6
Q

What two conditions result as a consequence of the alcohols affect on the liver

A

Steatoisis

Steatohepatits

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7
Q

How does steatosis occur in the liver

A

Alcohols interruption of lipid pathway metabolism results in fat being deposited in the liver

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8
Q

What is the pathology of steaohepatitis

A

Fat deposited in the liver triggers inflammation, as neutrophilial infiltration occurs
resulting in liver cell damage and death

This process of fibrosis occurs as scare tissue is deposited

This leads to `liver cirrhosis

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9
Q

What is the questions used in the CAGE questionnaire when taking a history of steaohepatitis

A

Have you ever felt the need to Cut down ?

Have you been Annoyed by criticism of your drinking?

Have you felt Guilty about your drinking?

Do you need an Eyeopener - need to drink in the morning?

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10
Q

What questioner is used to test the severity of alcohol usage

A

FAST/ AUDIT

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11
Q

When does the physical finding occur in alcohol damage to the liver

A

Advanced liver disease

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12
Q

What is the signs of chronic liver ddisease

A 
Spider naevi
palmar erythema, gynaecomastia (moobs) 
loss of axillary and pubic hair
ascites, encephalopathy 
Jaundice
Muscle wasting
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13
Q

What are the findings of Lab tests on chronic liver disease due to alcohol

A

Aspartate Amino Transferase (AAT) > alanine Amino Transferase (ALT). ratio

Raised Gamma Glutamyl Transferase

Macrocytosis - enlarged red blood cells

Thrombocytopenia (low platelets)

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14
Q

What is the AAT/alt ratio that indicated liver damage

A

> 2

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15
Q

What is the imaging diagnostic test for liver damage due to alcohol

A

Ultrasound - see if there is fat present on the liver

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16
Q

Define Hepatic encephalipathy

A

A feature of liver failure that goes on the affect brains toxicity due to high ammonia levels in the blood leading to the symptoms of confusion

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17
Q

What is the grading of Hepatic encephalipathy

A

Grade 1 - 4

  1. Mild confusion
  2. Coma
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18
Q

What can trigger Encephalopathy In liver disease

A 
Infection 
drugs
Constipation 
GI blled 
Electrolyte disturbance
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19
Q

What two things can also cause symptoms of Encephalopathy but aren’t related to liver disease

A

Hypoglyceamia

Intra cranial bled

An Infections out side the liver

  • need to still be investigated
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20
Q

What is the affect of alcohol on the citric acid cycle

A

Prevents citric acid cycle occurring, producing excess acetyl coA which leads to ketosis

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21
Q

What is the treatment of Encephalopathy

A

Bowel clear out (if constipation related)

Antibiotics - if due to an infection

Support:
Airway support
Nasogastric tube

22
Q

How does constipation with liver failure result in

Encephalopathy

A

In your faeces the urea is broken down to produce ammonia,

When you are constipated the ammonia is reabsorbed into the blood and the liver cant function properly

therefore remain in the blood and can travel to the brain and cause Encephalopathy

23
Q

What is the presentation of a patient with spontaneous bacterial peritonitis

A 
Abdominal pain 
Fevers/rigors 
Renal impairment 
Signs of sepsis 
(tachycardia, temperature)
24
Q

When does spontaneous bacterial peritonitis usually happen

A

In patients with acites due to liver failure that leads to infection

25
Q

What procedure is used for the diagnosis of spontaneous bacterial peritonitis

A

Ascitic tap

26
Q

What does ascitic tap test for

A

Fluid protein and glucose levels - indicated kidney function

Cultures - find out the infection

White cell count - Is an infection present

27
Q

What is an Ascitic tap

A

a needle is used to drain fluid that is trapped in an internal body cavity

28
Q

What is the results of Ascitic tap in spontaneous bacterial peritonitis

A

Low protein levels of <25g/L

High neutrophil level of > 0.25x109 /L

29
Q

What needs to be excluded in spontaneous bacteria peritonitis

A

Surgical cause of peritonitis

seen in high neutrophili level

30
Q

What is the treatment of spontaneous bacteria peritonitis

A

IV antibiotics
ascitic fluid drainage
IV albumin infusion

31
Q

What is the purpose of an IV albumin infusion

A

Improves kidney function

Preventing further leaking of fluid and draining acites

32
Q

What is the clinical presentation of alcohol hepatitis

A

Jaundice
Encephalopathy
Infection usually present
Decomplensated hepatic function

33
Q

What is an important sign of liver failure

A

Low albumin

Raised prothrombin =INR

34
Q

If you have abnormal LFTS does this indicate you are in liver failure

A

if your albumin levels are fine you aren’t in liver failure

35
Q

What are the biomarkers for alcohol hepatitis

A

raised GGT and Raised ALP (secreted by damaged liver cells)

36
Q

What are the two other factors that are needed for the diagnosis of alcoholic hepatitis

A

Raised Bilirubin

Alcohol History

37
Q

What is the prognosis of alcohol hepatitis

A

40% mortality

severe = 90% mortality

38
Q

What further developments increase the mortality rate

A

decompensating liver disease signs - 70%

Encephalopathy - 64%

39
Q

What does the prognosis depend highly upon

A

Abstinence or ongoing alcohol consumption

40
Q

How many months does the guideline state abstinence to alcohol before liver transplant consideration

A

6 months

41
Q

What is the management and treatment needed in alcohol hepatitis

A

Supportive
Airway Protection / ITU care

Treat infection

Treat encephalopathy

Treat alcohol withdrawal

Protect against GI bleeding

Nutrition

42
Q

What is the drug treatment given if the grading of alcohol hepatitis is severe

A

Oral prednisolone 40mg Steroid

43
Q

How is the treatment of nourishment given in alcohol hepatitis

A

Treat malnourishment

Feed frequently
High energy requirements

Give Thiamine - Vitamin B1

44
Q

What is the benefit of nourishment treatment

A

Increases 2 year survival from 15% to 70%

45
Q

What is the risk factors of fatty liver disease

A 
Obesity 
Diabetes 
Hypercholestolaemia 
{Alcohol}
Co-morbidity 
Benign - alone fat
46
Q

What is the two types of fatty liver

A

Non alcoholic Steatosis (fatty liver)

Non alcoholic Steatohepatitis
fatty liver with inflammation

47
Q

What is the pathology of fatty liver similar to

A

Similar to alcohol induced damage

48
Q

What can fatty liver go on to develop

A

cirrhosis

49
Q

What is the typical presentation of fatty liver

A

asymptomatic

50
Q

What investigations are used for diagnosing fatty liver

A

Blood test - High ALT (show inflamed liver)

Ultrasound - see fat

Liver biopsy

51
Q

What is the treatment of fatty liver disease

A

Weight loss

Exercise

Alimentary System: Pathology SA (27 decks)

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