Alcoholic Liver Disease Flashcards
(34 cards)
What can increase the risk of alcohol having a harmful effect on the liver? (2)
Obesity
Viral hepatitis
What are the 3 steps of progression of alcohol-related liver disease?
- Alcoholic fatty liver
- Alcoholic hepatitis
- Cirrhosis
What is the main treatment of alcoholic fatty liver?
Abstinence
It is completely reversible
Until what stage of alcohol related liver disease are the effects reversible on abstinence?
Mild alcoholic hepatitis
What are the benefits of stopping drinking in alcohol related liver cirrhosis?
It prevents further damage to the liver
What is the recommended alcohol consumption per week?
No more than 14 units a week
Spread over 3 or more days
No more than 5 units in a day
What is the definition of binge drinking?
6 or more units for women
8 or more units for men
What are some complications of drinking during pregnancy? (4)
Miscarriage
Small for dates
Preterm delivery
Fetal alcohol syndrome
What are some complications of alcohol? (9)
• Alcohol-related liver disease
• Cirrhosis and its complications (e.g., hepatocellular carcinoma)
• Alcohol dependence and withdrawal
• Wernicke-Korsakoff syndrome (WKS)
• Pancreatitis
• Alcoholic cardiomyopathy
• Alcoholic myopathy, with proximal muscle wasting and weakness
• Increased risk of cardiovascular disease (e.g., stroke or myocardial infarction)
Increased risk of cancer, particularly breast, mouth and throat cancer
What are some signs suggestive of excessive alcohol consumption? (5)
• Smelling of alcohol
• Slurred speech
• Bloodshot eyes
• Dilated capillaries on the face (telangiectasia)
• Tremor
What happened to the MCV suggesting alcohol-related liver disease?
It is raised
What LFTs would you see in alcohol-related liver disease?
Raised transaminases (AST:ALT ratio over 1.5)
Raised GGT
Raised ALP later in disease
Raised bilirubin in cirrhosis
What happens to the investigations suggestive of synthetic function of the liver in alcohol-related liver disease? (2)
• Low albumin due to reduced synthetic function of the liver
Increased prothrombin time due to reduced synthetic function of the liver (reduced production of clotting factors)
What does an ultrasound show in early alcoholic liver disease?
Fatty changes shown as increased echogenicity
How is ultrasound used in patients with liver cirrhosis?
Used to screen for HCC
What is transient elastography used for?
assess the elasticity of the liver using high-frequency sound waves. It helps determine the degree of fibrosis (scarring).
What medical management can be given in severe alcoholic hepatitis? What effects does it have?
Corticosteroids
Reduces inflammation short term
No long term outcomes
What are the general management principles of alcohol-related liver disease? (7)
• Stop drinking alcohol permanently (drug and alcohol services are available for support)
• Psychological interventions (e.g., motivational interviewing or cognitive behavioural therapy)
• Consider a detoxication regime
• Nutritional support with vitamins (particularly thiamine – vitamin B1) and a high-protein diet
• Corticosteroids may be considered to reduce inflammation in severe alcoholic hepatitis to improve short-term outcomes (but not long-term outcomes)
• Treat complications of cirrhosis (e.g., portal hypertension, varices, ascites and hepatocellular carcinoma)
• Liver transplant in severe disease (generally 6 months of abstinence is required)
What 2 questionnaires can be used to screen for harmful alcohol use?
CAGE
AUDIT
What is the CAGE questionnaire? What are the questions in it?
The CAGE questions can be used to quickly screen for harmful alcohol use:
• C – CUT DOWN? Do you ever think you should cut down?
• A – ANNOYED? Do you get annoyed at others commenting on your drinking?
• G – GUILTY? Do you ever feel guilty about drinking?
E – EYE OPENER? Do you ever drink in the morning to help your hangover or nerves?
What is the AUDIT questionnaire and how is it used?
The Alcohol Use Disorders Identification Test (AUDIT) was developed by the World Health Organisation to screen people for harmful alcohol use. It involves 10 questions with multiple-choice answers and gives a score. A score of 8 or more indicates harmful use.
What are the symptoms of alcohol withdrawal and what time frame do you experience each symptom? (4)
• 6-12 hours: tremor, sweating, headache, craving and anxiety
• 12-24 hours: hallucinations
• 24-48 hours: seizures
24-72 hours: delirium tremens
What type of substance is alcohol?
Depressant
What does alcohol do to GABA and glutamate receptors?
It stimulates GABA receptors in the brain.
GABA receptors have a relaxing effect on the rest of the brain.
Alcohol also inhibits glutamate receptors (also known as NMDA receptors), causing a further relaxing effect on the electrical activity of the brain (glutamate is an “excitatory” neurotransmitter).
