Gastro - Alcohol-Related Liver Disease Flashcards
What is the stepwise progression of alcohol-related liver disease?
- Alcoholic fatty liver (hepatic steatosis)
- Drinking causes fat build-up
- Reversible with abstinence - Alcoholic hepatitis
- Drinking alcohol over a long period causes inflammation in liver cells
- Usually reversible with permanent abstinence - Cirrhosis
- Hepatocytes replaced with scar tissue
- Irreversible
- Continued alcohol consumption has very poor prognosis
What is the recommended alcohol consumption?
14 units per week
Spread evenly over 3 or more days
Not more than 5 units in a day
What is binge drinking defined as?
6 or more units for women
8 or more units for men
In a single session
What does alcohol in early pregnancy lead to?
Miscarriage
Small for dates
Preterm delivery
Foetal alcohol syndrome
What are the complications of alcohol?
Alcohol related liver disease
Cirrhosis
Alcohol dependence and withdrawal
Wernicke-Korsakoff syndrome
Pancreatitis
Alcoholic cardiomyopathy
Alcoholic myopathy with proximal muscle wasting and weakness
Increased cardiovascular disease risk
Increased risk of cancer - breast and throat
What are the examination findings with excess alcohol?
Alcohol smell
Slurred speech
Bloodshot eyes
Dilated capillaries on face (telangiectasia)
Tremor
What blood test results suggest alcohol-related liver disease?
- Raised MCV
- Raised AST:ALT ratio, over 1.5
- Raised gamma-glutamyl transferase
- Raised ALP (later in disease)
- Raised bilirubin
- Low albumin
- Increased prothrombin time
- Deranged U&Es
What investigations can be used for alcohol-related liver disease?
- Liver ultrasound, may show early fatty changes with “increased echogenicity
- Transient elastography
- Endoscopy
- CT and MRI scans
- Liver biopsy
How is alcoholic-related liver disease managed?
STOP DRINKING
- Psychological interventions
- Detoxication regime
- Nutritional support with vitamins (thiamine and B1), high-protein diet
- Corticosteroids in severe alcoholic hepatitis
- Treat complications
- Liver transplant
What is alcohol dependence?
Daily alcohol consumption, strong urges and cravings, difficulty controlling consumption, tolerance to effects of alcohol
Withdrawal when stopping
What are CAGE questions?
Used to quickly screen for harmful alcohol use:
C Cut down? Do you ever think you should cut it 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?
Alcohol Use Disorders Identification Test
10 questions, score of 8 or more is harmful use
What symptoms can occur at different times in alcohol withdrawal?
6-12 hours
Tremor
Sweating
Headache
Craving
Anxiety
12-24 hours
Hallucinations
24-48 hours
Seizures
24-72 hours
Delirium tremens
What is delirium tremens?
Medical emergency associated with alcohol withdrawal
35% mortality if untreated
Extreme excitability of brain and excessive adrenergic activity
What is the pathophysiology of delirium tremens?
Alcohol is a depressant substance
Stimulates GABA receptors (inhibitory receptor)
Inhibits glutamate receptors (excitatory)
Causes relaxing effect on brain activity
Chronic alcohol use causes GABA downregulation and up-regulation of glutamate receptors
When alcohol is removed GABA under-function and glutamate over-functions causing extreme excitability and excessive adrenergic activity
