Alcoholic Liver Disease

Question 1

in the oxidative metabolism pathway what toxic carcinogen can build up?

Answer 1

acetaldehyde

Question 2

what is steatosis?

Answer 2

fat depositation in the liver

Question 3

what is steatohepatitis?

Answer 3

fat in the liver with inflammation (neutrophil infiltration, fibrosis, cirrhosis)

Question 4

what are the signs of chronic liver disease?

Answer 4

> spider naevi
> palmar erythema
> gynaecomastia
> loss of body hair
> ascites
> encephalopathy

Question 5

what physical finding could be found in alcohol related liver disease?

Answer 5

> none until advanced liver disease
signs of chronic liver disease
jaundice
muscle wasting

Question 6

would gamma glutamyl transferase be raised or lowered in alcoholic liver disease?

Answer 6

raised

Question 7

how would the platelet count be lowered in alcoholic liver disease?

Answer 7

lowered (thrombocytopenia)

Question 8

what investigations would be carried out for alcoholic liver disease?

Answer 8

ultrasound

Question 9

describe the grading system of hepatic encephalopathy

Answer 9

1 - 4

1: mild confusion
4: coma

Question 10

what can cause hepatic encephalopathy?

Answer 10

high levels of ammonia in the blood
> infection
> drugs
> constipation
> GI bleed
> electrolyte disturbance

Question 11

what causes do you need to exclude when dealing with hepatic encephalopathy?

Answer 11

> infection
hypoglycaemia
intracranial bleed

Question 12

what treatment is there for hepatic encephalopathy?

Answer 12

> bowel clear out, lactulose, enemas
antibiotics
supportive (ITU, Airways, nasogastric tube)

Question 13

what are the signs and symptoms of spontaneous bacterial peritonitis?

Answer 13

> abdominal pain
> fever
> rigors
> renal impairment
> sepsis
> tachycardia
> temperature

Question 14

what investigations would you carry out in spontaneous bacterial peritonitis?

Answer 14

> ascitic tap: fluid protein/glucose levels
cultures
white cell content

Question 15

what is the management for spontaneous bacterial peritonitis?

Answer 15

> IV antibiotics
ascetic fluid drainage
IV albumin infusion (to stop leakage back into cavity after drain)

Question 16

how does alcoholic hepatitis present?

Answer 16

> jaundice
enceohalopathy
decompensated hepatic function
infection

Question 17

what is needed to diagnose alcoholic hepatitis?

Answer 17

> raised bilirubin
raised GGT and AlkP
alcohol history
exclusion of other causes (cancer)

Question 18

what is the treatment for alcoholic hepatitis?

Answer 18

> supportive
> treat infection
> treat encephalopathy
> treat alcohol withdrawal
> protect against GI bleed
> protect airways
> steroids if grading is severe: Glasgow alcoholic hepatic score >9
> nutritional

Question 19

what is the prognosis of alcoholic hepatitis dependent on?

Answer 19

abstinence or ongoing alcohol consumption

Question 20

what is the prognosis of alcoholic hepatitis if there is any sign of decompensating liver disease?

Answer 20

70% mortality in 5years

Question 21

what is the prognosis of alcoholic hepatitis if encephalopathy is present?

Answer 21

64% in 1 year mortality

Question 22

what can cause fatty liver?

Answer 22

> diabetes
obesity
hypercholesterolaemia

Question 23

how many patients with steatohepatitis develop cirrhosis?

Answer 23

1/4

Question 24

how would you diagnose steatohepatitis?

Answer 24

> raised alanine amino transferase
ultrasound
liver biopsy

Question 25

what is the treatment for steatohepatitis?

Answer 25

> weight loss

> exercise