What are the features of alcoholic steatosis/stratosis?
- Macrovesicular steatosis with lipid vacuole filling the hepatocute cytoplasm
What are the features of alcoholic hepatitis/NASH?
- Neutrophils and lymphocytes surrounding hepatocytes with Mallory hyaline
What are the features of alcoholic cirrhosis/AFLD?
- Pericellular fibrosis as well as bands of fibrois tracts between portal tracts
What are the features of NAFLD?
- Increasing severity of NAFLD in patients with T2DM and HTN
What are the differences between ALD and NAFLD?
What are the features are usually seen on investigation of alcoholic hepatitis?
- Recent excess alcohol
- Bilirubin >80µmol/l
- Exclusion of other liver disease
- AST <500 (AST:ALT ratio >1.5)
- May show hepatomegaly +/- fever +/- leucocytosis +/- hepatic bruit
What are the elements of the Glasgow Alcoholic Hepatitis Score?
What are the signs of chronic liver disease?
- 'Synthetic dysfunction' (prolonged PT, hypoalbuminaemia)
- Portal hypertension (caput medusa, hypersplenism, thrombocytopenia)
What are the stages of chronic liver disease?
- 0) No fibrosis
- 1) Portal fibrosis
- 2) Portal fibrosis with septa
- 3) Bridging fibrosis (focal, diffuse or marked)
- 4) Cirrhosis
How is the severity of chronic liver disease assessed? (Evil Ascites Beats All Physicians)
How is ascited assessed?
- Cell count >500WBC/cm3 and >250 neutrophils/cm3 suggest spontaneous bacterial peritonitis
- Albumin involves the serum ascites albumin gradient (SAAG) which is serum albumin minus ascetic albumin g/l – SAAG >11g/l = portal hypertension
- Treatment involves low salt diet, diuretics (spironolactone, furosemide) and paracentesis
What scoring system is used to grade mental state in hepatic encephalopathy?
- Conn score (West Haven Classification)
- 0) No abnormality
- 1) Lack of awareness
- 2) Disorientation
- 3) Confusion/stupor
- 4) Coma
How is liver disease investigated?