Alcohol Related Disease Flashcards
(40 cards)
How does alcohol metabolisation differ between the sexes?
Women metabolise slower than men
Describe the pathways of ethanol metabolism?
- Alcohol dehydrogenase changes ethanol to acetaldehyde
- Acetaldehyde dehydrogenase changes acetaldehyde to acetate
How do patients present as a result of metabolism processes?
- Excess lipids
- Hypoglycaemic
- Acidotic
- Build up of ketones
What are 2 common presentations of alcohol and the liver?
- Staetosis
- Staetohepatitis
Steatosis
Fatty liver, non-alcoholic fatty liver (NAFLD)
Steatohepatitis
Fatty liver with inflammation, non-alcoholic steatohepatitis (NASH)
Why is there inflammation present with steatohepatitis?
- Neutrophil infiltration
- Fibrosis
- Cirrhosis
- Build up of scar tissue
What questions are included in the CAGE questionnaire?
- 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?
What is 1 unit of alcohol equivalent to?
- Half pint of regular beer, lager or cider
- 1 small glass of wine
- 1 single measure of spirits
- 1 small glass of sherry
- 1 single measure of aperitifs
When should patients complete an AUDIT questionnaire as well as a FAST questionnaire?
When they have an overall FAST score of 3 or more
What may the physical findings of a liver affected by alcohol be?
- Majority there is no physical findings until advanced disease
- Signs of chronic liver disease
- Jaundice
- Muscle wasting
What are signs of chronic liver disease?
- Spider naevi
- Palmar erythema
- Gynaecomastia
- Loss of axillary and pubic hair
- Ascites
- Encephalopathy
What laboratory investigations findings might there be?
-Aspartate amino transferase (AAT)> alanine amino transferase (ALT). Ratio >2
-Raised gamma glutamyl transferase
Macrocytosis
-Thrombocytopenia (low platelets
What findings might be found on investigation?
-USS of fatty liver
What is hepatic encephalopathy due to?
Liver failure leading to a build up of ammonia
How is hepatic encephalopathy graded?
- Graded 1-4
- 1: mild confusion
- 4: coma
What can cause hepatic encephalopathy?
- Infection
- Drugs
- Constipation
- GI bleed
- Electrolyte disturbance
What should be excluded first before diagnosing hepatic encephalopathy?
- Infection
- Hypoglycaemia
- Intra cranial bleed
What is the treatment for hepatic encephalopathy?
- Bowel clear out, lactulose, enema
- Antibiotics
- Supportive
What does supportive treatment include for hepatic encephalopathy?
- ITU
- Airway support
- NG tube for meds
How does spontaneous bacterial peritonitis present?
- Abdominal pain
- Fever
- Rigors
- Renal impairment
- Signs of sepsis, tachycardia, temperature
What should the fluid from an ascites tap be tested for?
- Fluid protein and glucose levels
- Cultures
- White cell content
Before diagnosing spontaneous bacterial peritonitis what should be excluded?
Surgical causes of peritonitis
What is the neutrophil count in spontaneous bacterial peritonitis?
> 0.25x10^9/L
