Alcoholic liver disease

Question 1

Describe the stages in the stepwise progression of alcoholic liver disease

Answer 1

1. Alcohol related fatty liver
2. Alcoholic hepatitis
3. Cirrhosis (irreversible)

Question 2

Men and women are recommended not to drink more than (..?) units of alcohol per week

Answer 2

14 units

Question 3

What are the components of the CAGE questionnaire?

Answer 3

C = cut down
A = annoyed
G = guilty
E = eye-opener

Question 4

Which questionnaire can be used to screen patients for harmful alcohol use?

Answer 4

AUDIT (Alcohol Use Disorders Identification Test) questionnaire

Question 5

Give some examples of complications of alcohol use

Answer 5

• ALD
• Cirrhosis (and HCC)
• Alcohol dependence and withdrawal
• Wernicke-Korsakoff syndrome
• Pancreatitis

Question 6

Which signs may you find in a patient with liver disease…

a) On general inspection
b) On inspection of the hands
c) On inspection of the chest/abdomen
d) On palpation of the abdomen

Answer 6

a) Jaundice
b) Palmar erythema, asterixis (decompensated ALD)
c) Gynaecomastia, spider naevi, caput medusae, ascites
d) Hepatomegaly

Question 7

What picture would you expect to see on LFTs in a patient with alcoholic liver disease?

Which tests are used to determine the “synthetic function” of the liver? What might these show in a patient with ALD?

Answer 7

Picture on LFTs typically shows hepatocellular damage - raised AST and ALT (transaminases). GGT also raised.

Synthetic function = albumin (low in ALD) and clotting (prolonged in ALD due to reduced production of clotting factors by the liver)

Question 8

What may you see on FBC in a patient with ALD?

Answer 8

Macrocytic anaemia

Question 9

Which initial imaging investigation can be used to look for fatty/cirrhotic changes in the liver?

Answer 9

USS

Question 10

Which type of scan is used to check the elasticity of the liver to assess the degree of cirrhosis?

Answer 10

FibroScan

Question 11

Which investigation can be used to assess for and treat oesophageal varices in patients with ALD?

Answer 11

Endoscopy

Question 12

Describe the symptoms of alcohol withdrawal

When do these symptoms typically start to present?

Answer 12

6-12 hours: sweating, tremor, tachycardia, anxiety
12-24 hours: hallucinations
24-72 hours; seizures, delirium tremens

Question 13

What is delirium tremens?

Answer 13

Rapid onset of acute confusion and agitation caused by alcohol withdrawal

Question 14

What are the most dangerous problems associated with delirium tremens?

Answer 14

• Hyperthermia
• Seizures
• Arrythmias

Question 15

Which scoring tool is used to assess the patient’s alcohol withdrawal symptoms and guide subsequent treatment

Answer 15

CIWA-Ar (clinical institiute withdrawal assessment - alcohol revised)

Question 16

Which drugs can be used to control the symptoms in acute alcohol withdrawal?

Answer 16

Benzodiazepines:

• Chlordiazepoxide
• Diazepam

Question 17

Which medication is used to try to prevent Wernicke-Korsakoff syndrome?

Answer 17

Pabrinex

Question 18

What causes Wernicke-Korsakoff syndrome?

Answer 18

Thiamine (vitamin B1) deficiency caused by alcohol excess (thiamine is poorly absorbed in the presence of alcohol)

Question 19

What are the symptoms/signs of Wernicke’s encephalopathy?

Answer 19

CAN OPeN:

• Confusion
• Ataxia
• Nystagmus
• Ophthalmoplegia
• Peripheral Neuropathy

Question 20

Wernicke’s encephalopathy has a high mortality rate if left untreated… True or false?

Answer 20

True

Question 21

What are the signs and symptoms of Korsakoff’s syndrome?

Answer 21

• Memory impairment (antegrade and retrograde)

- Confabulation

Question 22

Is Korsakoff’s syndrome reversible?

Answer 22

No