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Flashcards in Alcoholic Liver Disease Deck (35)
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1
Q

⚡⚡ MOST COMMON CAUSE of LIVER CIRRHOSIS IN INDIA

⚡⚡ MOST COMMON CAUSE of LIVER CIRRHOSIS IN WESTERN COUNTRIES

A

⚡⚡ MOST COMMON CAUSE of LIVER CIRRHOSIS IN INDIA
🎯 ALCOHOLIC LIVER DISEASE

⚡⚡ MOST COMMON CAUSE of LIVER CIRRHOSIS IN WESTERN COUNTRIES
🎯 HCV > ALD

2
Q

1 Standard.Drinks

A

14 gm Alcohol
18ml of 100% alcohol

3
Q

Recommended Safe Limit

A

♂️: ≤ 2 Standard Drink
✨ 20-40 gm/day

♀️: ≤ 1 Standard Drink
✨ 16-30 gm/day

4
Q

⭐ How much ml of BEER is Standard Drink? (5%)

⭐ How much ml of WINE is Standard Drink? ( 12%)

⭐ How much ml of VODKA, GIN, RUM, WHISKEY is Standard Drink? (40%)

A

⭐ How much ml of BEER is Standard Drink? (5%)
🎯 350 ml

⭐ How much ml of WINE is Standard Drink? ( 12%)
🎯 150 ml

⭐ How much ml of VODKA, GIN, RUM, WHISKEY is Standard Drink? (40%)
🎯 44 ml

5
Q

When does a person develops ALCOHOLIC liver DISEASE?

A

Male:
✨ > 21 standard drinks/wk for ≥ 2 year
✨ > 210 gm/week for ≥ 2 year

Female:
✨ > 14 standard drinks/wk for ≥ 2 year
✨ > 140 gm/week for ≥ 2 year

6
Q

Pathogenesis of ALCOHOLIC LIVER DISEASE

A
7
Q

Effects of ⬆️ NADH DUE TO: Alcohol

A

Indicates ENERGY FULL STATE in Liver
⬇️
Energy Synthesis
⬇️
Fat synthesis⬆️
⬇️
Steatosis & Steatohepatitis⬆️

8
Q

ALCOHOLIC Liver DISEASE Spectrum

A
  1. Fatty Liver (Steatosis)
  2. Alcoholic Hepatitis (Steatohepatitis)
  3. Cirrhosis
  4. HCC
9
Q

⚡⚡ MOST COMMON HEPATOTOXIN causing ACUTE LIVER FAILURE

⚡⚡ MOST COMMON HEPATOTOXIN causing CHRONIC LIVER FAILURE

A

⚡⚡ MOST COMMON HEPATOTOXIN causing ACUTE LIVER FAILURE
🎯 ACETAMINOPHEN

⚡⚡ MOST COMMON HEPATOTOXIN causing CHRONIC LIVER FAILURE
🎯 Alcohol

10
Q

⭐ DIRECT HEPATOTOXIN

⭐ INDIRECT HEPATOTOXIN

A

⭐ DIRECT HEPATOTOXIN
🎯 Alcohol

⭐ INDIRECT HEPATOTOXIN

11
Q

Laennac CIRRHOSIS seen in

A

⭐ Alcoholic CITRHOSIS
SHOWS HOBNAIL PATTERN

12
Q

HOBNAIL in MEDICINE

A

⭐ HOBNAIL PATTERN: ALCOHOLIC CIRRHOSIS (Laennac)

⭐ HOBNAIL CELLS: Collecting Duct (OR) Bellini Duct RCC

⭐ HOBNAIL CELLS: Clear Cell Ovarian Tumour

13
Q

Identify

A

Mallory Hyaline Bodies
(OR)
Mallory Denk Bodies
✨ Eosinophilic Inclusion in Hepatocytes

14
Q

Composition of Mallory Hyaline Bodies

A

Intermediate Filaments like CK8 & CK18

15
Q

Mallory Hyaline Bodies found in
🧠⚡ New Indian WATCH⚡

A
  1. NASH
  2. Indian Childhood Cirrhosis
  3. Wilson’s disease
  4. Alpha 1 antitrypsin Disease
  5. Alcoholic Liver Disease
  6. Tumours: HCC
  7. 1° biliary Cirrhosis
  8. hyperplasia: Focal Nodular
16
Q

Decreased Attenuation in CT Liver

A

Fatty Liver

17
Q

USG feature of Alcoholic Fatty Liver

A

⬆️ LIVER ECHOGENICITY

18
Q

How to differentiate AFLD & NAFLD

A
  1. H/O Alcoholic Liver Disease
  2. LFT is deranged (AST > ALT)
19
Q

⚡⚡ MOST COMMON Presentation of ALCOHOLIC fatty liver

A

Hepatomegaly ± Pain

20
Q

Liver Profile of ALCOHOLIC FATTY LIVER

A
  1. AST/ALT > 1
  2. Moderate ⬆️ in ALT & AST
  3. GGT ⬆️ ⬆️
21
Q

🧑🏻‍⚕️ Clinical Features of ALCOHOLIC HEPATITIS

A

Constitutional symptoms (Fever, Fatigue, Anorexia & Tachycardia)

1. Tender Hepatomegaly
2. Jaundice
3. Splenomegaly
4. ASCITES (Portal HTN)
5. Evidence of Liver Failure

22
Q

LFT in ALCOHOLIC HEPATITIS

A
  1. AST & ALT ⬆️ (2-7 x Normal)
  2. AST/ALT ≥ 2:1
  3. PT/INR ⬆️
  4. Bilirubin ⬆️
23
Q

Alcoholic Hepatitis can be seen on TOP of Liver CIRRHOSIS

A
24
Q

Indication of treatment in ALCOHOLIC HEPATITIS

A

Discrimination Factor ≥ 32

25
Q

Maddrey Discrimination Score used in

A

Alcoholic HEPATITIS
✨ For indication of initiation of STEROIDS

26
Q

Maddrey Discrimination Score

A

= 4.6*(Prothrombin time - Control Prothrombin Time) ➕ Total Serum Bilirubin

27
Q

🚫 CONTRAINDICATION of STEROIDS even if MADDREY DISCRIMINATION SCORE ≥ 32

A
  1. Active UGI Bleed
  2. Active Infection
  3. HBV / HCV
28
Q

💊💉 MANAGEMENT of ALCOHOLIC HEPATITIS

A
  1. Prednisolone: 40mg/day * 18/days ➕ Taper in 16 days
    ⬇️
    Assess after 1 week with Lille’s Score
    ⬇️
    No improvement: Stop Steroids
  2. Pentoxyfylline (PDE ⛔)
29
Q

Lille’s score

A

Used to assess Response to STEROIDS in ALCOHOLIC HEPATITIS

30
Q

MELD Score > 11 indicates

A

Mortality in 30 days

31
Q

ABIC Score

A

Modification of MELD Score

✨ AGE
✨ Bilirubin
✨ INR
✨ Creatinine

32
Q

ALCOHOLIC CIRRHOSIS
Characteristic Features

A

✨ Parotid Enlargement
✨ Dupuytren’s contracture

33
Q

Microvesicular Steatosis
Causes
🧠⚡READ ⚡

A
  1. Reye’s Syndrome
  2. Early ALCOHOLIC liver disease
  3. Acute Fatty Liver of Pregnancy
  4. Drugs & Toxins
34
Q

Macrovesicular Steatosis
🧠⚡NOC PLz ⚡

A
  1. NASH
  2. Obesity
  3. C HEPATITIS CHRONIC infection
  4. Protein Energy Malnutrition
  5. Late ALCOHOLIC Liver Disease
35
Q

Periportal Predominant Macrovesicular Steatosis
🧠⚡ Total SPACE⚡

A
  1. Total Parenteral Nutrition
  2. Starvation
  3. Phosphorus poisoning
  4. AIDS
  5. Chronic Hepatitis C
  6. Exogenous Steroids