Alcoholic Liver DIsease Flashcards
What is alcohol related fatty liver?
Drinking leads to a build up of fat in the liver
If drinkings stops, process reversed in around 2 weeks
What is the progression of Alcoholic liver disease?
- Alcohol related fatty liver
- Alcoholic hepatitis
- Cirrhosis
What is alcoholic hepatitis?
Drinking alcohol over a long period causes inflammation in the liver sites
Binge drinking is associated with the same effect
Mild alcoholic hepatitis is usually reversible with permanent abstinence
What is the recommended weekly alcohol consumption?
14 units
Should be spread over 3 or more days
No more than 5 units a day
What is the CAGE questionnaire?
C - Cut down - thought you should
A - Annoyed - Do you get annoyed at others commenting on your drinking?
G - Guilty - ever felt guilty about drinking
E - Eye opener - in morning to help hangover/nerves
What is the AUDIT questionnaire?
Alcohol Use Disorders Identification Test
>8 is indication of harmful use
What are the complications of alcohol use? (6)
Alcoholic Liver Disease Cirrhosis and the complications of cirrhosis including hepatocellular carcinoma Alcohol Dependence and Withdrawal Wernicke-Korsakoff Syndrome (WKS) Pancreatitis Alcoholic Cardiomyopathy
Signs of Liver Disease (9)
Jaundice Hepatomegaly Spider Naevi Palmar Erythema Gynaecomastia Bruising – due to abnormal clotting Ascites Caput Medusae – engorged superficial epigastric veins Asterixis – “flapping tremor” in decompensated liver disease
Blood results in alcoholic liver disease
Bloods
FBC - raised MCV
LFTs - elevated ALT and AST (transaminases)
Particularly Gamma-GT
ALP raised later in the disease
Low albumin, elevated PTT due to reduced synthetic function
Elevated bilirubin in cirrhosis
Investigations in alcoholic liver disease
USS - increased echogenicity (fatty changes)
FibroScan checks elasticity of liver and helps assess degree of cirrhosis
Endoscopy - Assess and treat oesophageal varices when portal hypertension is suspected
CT/MRI looks as fatty infiltration of liver
Liver biopsy - used to confirm diagnosis of alcohol related hepatitis or cirrhosis
What is the general management? (6)
Stop drinking alcohol permanently
Consider a detoxification regime
Nutritional support with vitamins (particularly thiamine) and a high protein diet
Steroids - short term outcomes (over 1 month) in severe alcoholic hepatitis - infection and GI bleeding need to be treated first
Treat complications of cirrhosis (portal hypertension, varices, ascites and hepatic encephalopathy)
Referral for liver transplant (3 months abstinence)
Stages of withdrawal
6-12 hours: tremor, sweating, headache, craving and anxiety
12-24 hours: hallucinations
24-48 hours: seizures
24-72 hours: “delerium tremens”
What is delirium tremens?
Medical emergency
Mortality of 35% if left untreated
Alcohol 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) having a further inhibitory effect on the electrical activity of the brain
Chronic alcohol use - GABA system up-regulated, glutamate systemdown-regulated
When alcohol is removed from the system, GABA under-functions and glutamate over-functions causing an extreme excitability of the brain with excess adrenergic activity
How does delirium tremens present? (9)
Acute confusion Severe agitation Delusions and hallucinations Tremor Tachycardia Hypertension Hyperthermia Ataxia (difficulties with coordinated movements) Arrhythmias`
How is alcohol withdrawal treated?
CIWA-Ar (Clinical Institute Withdrawal Assessment – Alcohol revised) tool used to score the patient and guide treatment
Chlordiazepoxide (Librium) is a benzo
Continued for 5-7 days
IV high dose vitamin B vitamins (pabrinex)
Followed by regular lower dose thiamine
