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Flashcards in Alcohol Related Liver Disease Deck (37)
1

List some of the conditions of the liver that alcohol causes

Alcoholic hepatitis
Encephalopathy
Sponstaneous Bacterial Peritonitis
Fatty Liver Disease

2

Do we all metabolise alcohol the exact same way?

No.
Genetic variation
Women metabolise slower than men

3

Describe the oxidative metabolism of ethanol

Ethanol converted to acetaldehyde by alcohol dehydrogenase.
Acetaldehyde converted to acetate by acetaldehyde dehydrogenase

4

Describe the microsomal enzyme oxidation system of ethanol

ethanol is converted to acetaldehyde by cytochrome P4502E1

5

Give two pathways alcohol blocks in metabolism

Fat metabolism (leading to fatty liver)
Gluconeogenesis (may lead to hypoglycaemia)

6

What is steatosis?

Fatty Liver

7

What is steatohepatitis?

Inflammatory response to large fatty change in liver.

Neutrophil infiltration
Fibrosis and cirrhosis

8

What are the CAGE questions for taking an alcoholic history?

Have you ever felt the need to CUT down?
Have you ever been ANNOYED by criticism of your drinking?
Have you ever felt GUILTY about your drinking?
Do you need an EYEOPENER?

9

What is 1 unit of alcohol?

Half a pint of regular beer or cider
1 small glass of wine
25ml measure of spirits
1 small glass of sherry

10

What is FAST/AUDIT?

Questionnaire to asses alcoholic liver disease risk.
If FAST positive you carry out an AUDIT.

11

When do physical findings present in alcoholic liver disease?

Quite advanced disease
Majority often present with no physical signs

12

What are some of the signs of alcoholic liver disease?

Spider naevi,
Palmar erythema
Gynocomastia
Loss of auxiliary and pubic hair
Ascites
Encephalopathy
Jaundice (serious)
Muscle wasting

13

What labs can you find in alcoholic liver disease?

Aspartate Amino Transferase (AAT) > Alanine Amino Transferase (ALT) RATIO >2
Raised Gamma Glutamyl Transferase
Macrocytosis
Thrombocytopenia (low platelets)

These aren't necessarily diagnostic but are usually seen

14

What is macrocytosis?

Enlargement of RBC's due to bone marrow dysplasia
Alcohol is toxic to the bone marrow

15

What clinical sign does cause Thrombocytopenia?

Petechia

16

What investigation will show a fatty liver?

USS
Fatty liver is invariably found in alcoholic disease

17

What is hepatic encephalopathy?

Confusion, altered levels of consciousness or coma
This is due to liver failure and a build up of toxins as a result

Graded 1-4
1 = Mild Confusion, 4 = Coma

18

What are the causes of encephalopathy?

Im Confused (because i) Eat Good Drugs

Infection
Constipation
Electrolyte disturbance
GI Bleed
Drugs

19

When someone presents with hepatic encephalopathy what should you exclude?

Infection (more common in alcoholics)
Hypoglycaemia (again associated with alcohol)
Intracranial bleed (may have fallen over if drunk)

20

What is the treatment for hepatic encephalopathy?

Bowel clear out, lactulose, enemas
Antibiotics (infection screen)
Supportive
-ITU, airway support (coma)
-Nasogastric tube for meds

21

How may someone present with spontaneous bacterial peritonitis?

ASCITES
Abdominal pain
Fever, rigors
Renal impairment
Signs of sepsis, tachycardia, temperature

22

How do you diagnose spontaneous bacterial peritonitis?

Ascetic tap
-Fluid and protein levels (protein 0.25x10^9/L)

23

What is the treatment for spontaneous bacterial peritonitis?

IV antibiotics
Ascitic fluid drainage
IV albumin infusion

24

What other causes of peritonitis must be excluded when someone presents with what you think is spontaneous bacterial peritonitis?

Surgical causes of peritonitis

25

How does alcoholic hepatitis present?

Jaundice
Encephalopathy
Infection common
Decompensated hepatic function
-Low albumin and increased prothrombin time/ INR)

26

How do you diagnose alcoholic hepatitis?

Raised bilirubin
Raised GGT and AlkP
Alcohol History (+jaundice then probably this)
Exclude other causes

27

What is the prognosis of alcoholic hepatitis?

Poor
40% mortality
if severe up to 90%

28

What is the treatment for alcoholic hepatitis?

Supportive
Treat infection
Treat encephalopathy
Treat alcohol withdrawal
Protect against GI bleed (risk of PU and Vatical bleed)
Airway protection/ITU care

Steroids
Nutrition

29

When can you consider steroids in alcoholic hepatitis?

Severe disease

Large side effects so risk will only be less than benefit in severe disease.

Glasgow Alcoholic hepatitis score of >9
Modified Maddrey's discriminant function >32

Then treat with oral steroids

30

What treatment is the most important in alcoholic hepatitis?

NUTRITION

100% of patients with alcoholic hepatitis are malnourished
33% severely
2 year survival increases from 15% to 70% if nourished
ABSOLUTE FUCKING SHIT TON OF THIAMINE
Frequent feeds, high energy requirement
(body working hard to repair liver)

31

Can you get steatosis not associated with alcohol?

Yes
Non-Alcoholic Fatty Liver Disease (NAFLD)

32

Can you get steatosis in a patient who doesn't drink alcohol?

Yes
Non-Alcoholic Steatohepatitis (NASH)

33

How do patients present in NASH compared with alcohol associated steatohepatitis?

The same

34

What is the epidemiology of fatty liver and what are the causes?

25-40% of the population
Obesity
Diabetes
Hypercholesterolaemia
(alcohol)

?beinign

35

How many people with steatohepatitis will go on to develop cirrhosis?
How does this compare to steatosis?

Steatohepatitis -> cirrhosis =25%
Steatosis -> cirrhosis = 1-2%

36

How does steatohepatitis present?
What investigations can you carry out?

Asymptomatic

Raised Alanine Amino Transferase (AAT)
Fatty Liver on USS
Liver Biopsy

37

What are the treatments for steatohepatitis?

Exercise
Weightloss