Flashcards in Alcoholic Hepatitis Deck (31)
How many grams of ethanol is in one unit of alcohol.
What is the weekly threshold of units (of alcohol) for women.
What is the weekly threshold of units (of alcohol) for men.
How long after consumption, does alcohol reach peak blood concentration.
After 20 mins. (Although this is influenced by stomach contents).
How is alcohol metabolized by the liver. (2)
Approximately 80% of alcohol is metabolised to acetaldehyde by alcohol dehydrogenase. Acetaldehyde is then metabolized to acetyl-CoA and acetate by alcohol dehydrogenase, This generates NADH from NAD.
Acetaldehyde forms addicts with cellular proteins in hepatocytes that activate the immune system, contributing to cell injury.
The remaining 20% is metabolized by Cytochrome CYP2E1, which oxidises ethanol to acetate. During metabolism of ethanol, it releases oxygen free radicals, leading to lipid peroxidation and mitochondrial damage.
Why are chronic alcoholics more susceptible to hepatotoxicity from low doses of paracetamol.
The CYP2E1 enzyme that metabolizes ethanol also metabolizes acetaminophen.
What are the pathological features (histological) of alcoholic liver disease. (7)
Fibrosis and Cirrhosis.
Central Hyaline Sclerosis.
What percentage of patients presenting with severe alcoholic hepatitis, will have coexisting cirrhosis.
What are the three broad categories of alcoholic liver disease.
Fatty liver disease.
What are the clinical features of alcoholic hepatitis (acute). (7)
Features of portal hypertension (ascites, encephalopathy)
What are the two most common signs at presentation of alcoholic hepatitis.
What is the mortality rate for patients with alcoholic hepatitis.
About 30% of patients die in the acute episode.
Even if patients abstain from alcohol, how long may it take for the jaundice to resolve.
Up to 6 months.
What is the 3 ande 5 year survival rate for patients presenting with jaundice in alcoholic hepatitis, who then abstain.
3 and 5 year survival is 70%
What is the 3 and 5 year survival rate for patients presenting with jaundice in alcoholic hepatitis, who continue to drink,
3 year survival = 60%.
5 year survival = 34%
What are investigations used for when you suspect alcohol misuse.
Investigations are used to establish alcohol misuse, to exclude alternative or additional coexisting causes of liver disease, and to assess the severity of liver damage.
What tests are used to determine alcohol misuse, and what would you expect to see.
1. LFTs = raised GGT, low albumin, high serum bilirubin, high serum AST and ALT, high serum alkaline phosphatase, high prothrombin time. However, a raised GGT is not specific for alcohol misuse.
2. FBC: raised MCV, low platelets, raised cholesterol, raised IgA, leucocytosis. Macrocytosis in the absence of anaemia may suggest and support a history of alcohol misuse.
4. Liver biopsy will give the exact degree of liver damage, but it is not required for initial diagnosis of alcoholic liver disease.
What is the Maddrey score.
The Maddrey score is used in alcoholic hepatitis to determine the prognosis of the patient.
It uses the prothrombin time and bilirubin.
What is the treatment for alcoholic hepatitis.
1. Abstinence of alcohol. (treat for withdrawal symptoms - chlordiazepoxide/lorazepam)
2. Nutritional advice.
3. Vitamin replacement. (vitamin K, thiamine)
6. Liver transplantation. (poor outcome for cases of alcoholic hepatitis, so is seldom done due to the fact that many return to drinking).
What percentage of those with alcoholic hepatitis progress to liver cirrhosis.
What percentage of those with alcoholic hepatitis progress to hepatic failure.
What two conditions is it important to identify and anticipate when admitting a patient presenting with symptoms of alcoholic liver disease.
Alcohol withdrawal symptoms.
You should treat these in parallel with the liver disease along with any complications of cirrhosis.
What is a side effect of steroid treatment of alcoholic hepatitis.
What are the main contraindications of using steroids to treat alcoholic hepatitis. (2)
How long should you wait for steroids to work in someone with alcoholic hepatitis.
If the bilirubin has not fallen 7 days after starting steroids, the drugs are unlikely to reduce mortality and should be stopped.
What are the benefits of treating alcoholic hepatitis with pentoxifylline. (2)
It reduces the incidence of hepatorenal failure.
Its use is not complicated by sepsis.
How is a diagnosis of alcoholic hepatitis made in cases of mild to moderate symptoms.
What is Zieve's syndrome.
It is rare and is hyperlipidaemia with haemolysis.
It is a metabolic condition that can occur during withdrawal from prolonged alcohol abuse.
If necessary, how is a liver biopsy performed in a patient with alcoholic hepatitis.
Via the transjugular route.
This is due to the prolongued PT.