Alcohol Related Liver Disease

Question 1

What effect does alcohol have on the liver?

Answer 1

It is directly toxi

Question 2

Why does alcohol affect us differently?

Answer 2

Depends on our genetics and how we metabolise alcohol

Question 3

Who metabolises alcohol slower men or womeb?

Answer 3

Women

Question 4

What is the toxic product of alcohol breakdown?

Answer 4

Acetaldehyde

Question 5

What is acetaldehyde broken down to in the liver?

Answer 5

Acetate

Question 6

What enzyme breaks ethanol down to acetaldehyde and acetate?

Answer 6

Alcohol dehydrogenase

Acetaldehyde dehydrogenase

Question 7

Where is alcohol broken down?

Answer 7

In the liver

Question 8

Which organ is vital for metabolism?

Answer 8

The liver

Question 9

When the liver is metabolising alcohol what is interrupted?

Answer 9

Other metabolic pathways of the liver
E.g breakdown of fats
Or breakdown of glycogen to glucagon

Question 10

What is steatosis?

Answer 10

Fatty liver

Can be either alcohol or non-alcohol related

Question 11

What causes steatosis?

Answer 11

The presence of fat dumped in the liver

Question 12

What is steatohepatitis?

Answer 12

Fatty liver with inflammation

Question 13

What causes steatohepatitis?

Answer 13

The fat causes inflammation

Neutrophils infiltrate

Question 14

Given an example of one unit of alchohol

Answer 14

Half pint of regular beer
1 small glass of wine
1 single measure of spirits
1 small glass of sherry

Question 15

What are the clinical signs of steatosis and steatohepatitis?

Answer 15

Majority will show no physical findings until they present with advanced liver disease

Question 16

What are the signs of chronic liver disease?

Answer 16

Spider naevi 
Palmar erythema 
Gynaecomastia 
Loss of axillary and pubic hair 
Ascites 
Encephalopathy (confusion)
Jaundice 
Muscle wasting 
Hepatomegaly

Question 17

What labs are suggestive of chronic liver disese?

Answer 17

AAT>ALT 
Raised GGT 
Macrocytosis (enlarged RBC)
Thrombocytopenia (low platelets) 
Increase bilirubin 
USS fatty liver

Question 18

What is raised GGT a sign of?

Answer 18

Excessive alcohol consupmtion

Question 19

What is hepatic encephalopathy?

Answer 19

Confusion and issues caused by high ammonia levels in the system

Question 20

How is hepatic encephalopathy graded?

Answer 20

Grade 1 - 4

Question 21

What is grade 1 in hepatic encephalopathy?

Answer 21

Mild confusion

Question 22

What is grade 4 hepatic encephalopathy?

Answer 22

Coma

Question 23

What are the causes of hepatic encephalopathy?

Answer 23

Infection 
Drugs 
Constipation 
GI bleed
Electrolyte disturbance

Question 24

How does constipation cause hepatic encephalopathy?

Answer 24

A lot of ammonia gets passed out in faeces
So if constipated a lot gets backed up
A lot of ammonia is reabsorbed into the system
Travelling up to the brain

Question 25

What is the treatment for hepatic encephalopathy?

Answer 25

Bowel clear out Antibiotics Supportive - ITU, Airway control, NG tube

Question 26

What is spontaneous bacterial peritonitis?

Answer 26

Spontaneous infection in the peritoneal cavity

Question 27

What are the symptoms of spontaneous bacterial peritonitis?

Answer 27

``` Abdominal Pain Fever - Due to infection Rigors Renal impairment Signs of sepsis Tachycardia Ascites ```

Question 28

What is ascitic tapping?

Answer 28

Removing small amounts of the ascitic fluid from the abdomen

Question 29

What is measured in an ascitic tap?

Answer 29

WCC Protein and glucose levels Culture

Question 30

Why is a culture done in an ascitic tap?

Answer 30

To test for any pathogens

Question 31

What is the treatment for spontaneous bacterial peritonitis?

Answer 31

IV antibiotic Ascitic fluid drainage IV albumin infusion

Question 32

What is the presentation of alcoholic hepatitis?

Answer 32

``` Jaundice Encephalopathy Infection is common Decompensated hepatic function Low albumin Raised prothrombin time ```

Question 33

What are the diagnostic markers for alcoholic hepatitis?

Answer 33

Raised bilirubin Raised GGT and AlkP Alcohol History

Question 34

What is the treatment for alcoholic hepatitis?

Answer 34

``` Supportive care Treat infection Treat encephalopathy Treat alcohol withdrawal - Fluid - diazepam Protect against GI bleeding Airway protection ITU ```

Question 35

Which score gives you a high mortality risk in alcoholic hepatitis?

Answer 35

>9

Question 36

If alcoholic hepatitis grading is severe what should it be treated with?

Answer 36

Steroids

Question 37

What is the prognosis in alcoholic hepatitis dependant on?

Answer 37

If the patient is willing to give up alcohol or not

Question 38

What do you need to do to qualify for liver Tx?

Answer 38

Give up alcohol

Question 39

What is NAFLD and NASH related to?

Answer 39

``` DM Obesity Hypertriglyceridemia Hypertension Hypertlipidaemia ```

Question 40

What causes NASH?

Answer 40

Fat deposition leading to inflammation

Question 41

What can be some signs of NASH?

Answer 41

Raised AAT Fatty liver on USS Liver biopsy -> histology show white fatty deposits

Question 42

What is the treatment for NASH?

Answer 42

Weight loss Exercise Trying to reverse the cause

Question 43

What is NAFLD?

Answer 43

Spectrum of diseases from steatosis-steatohepatitis - Fibrosis- cirrhosis

Question 44

What are symptoms of NAFLD that has severely progressed?

Answer 44

Pain right upper quadrant Jaundice Hepatomegaly Ascites

Question 45

What is alcohol induced steatosis?

Answer 45

Fatty liver due to alcohol

Question 46

What can alcohol induced steatosis lead to?

Answer 46

Alcoholic hepatitis

Question 47

Which is more raised in alcohol liver disease AST or ALT?

Answer 47

AST

Question 48

Treatment for alcohol liver disease?

Answer 48

Stop alcohol consumption

Question 49

What is raised GTT LFT a sign of

Answer 49

Alcohol related

Question 50

When is alcoholic hepatitis treated with oral corticosteroids?

Answer 50

When maddrey's discriminant >32

Question 51

Which score is used to stage alcoholic hepatitis?

Answer 51

Glasgow Alcoholic Hepatitis Score