22. Alcoholic liver disease Flashcards
what are the three stages of alcoholic liver disease ?
alcoholic fatty liver - reversible
more than 50pecent of hepatocytes re with fatty liver deposition
alcoholic steatohepatitis becoming chronic
= reversible in mild cases
cirrhosis
they can all be present and overlapping
what are the signs and symptoms for alcoholic liver disease ?
steatosis
asymptomatic and hepatomegaly discomfort in right upper quadrant
alcoholic hepatitis jaundice hepatomegaly weight loss = anorexia right upper abdominal pain fever tachycardia
cirrhosis
heaptosplenomegaly (splenomegaly indicates cirrhosis)
jaundice , ascitis , esophageal varicies
decrease concentration maybe first sign of hepatic encephalopathy
caput medusa
what is the pathophysiology of alcoholic liver disease ?
ethanol via alcohol dehydrogenase gets oxidised to acetyaldehyde
acetylaldehyde goes to acetate via aldehyde dehydrogenase
acetate combines with CoA forming acetyl CoA
increase in NADH and ad acetyl CoA
acetylCoA is needed for the synthesis of fatty acids
= fat accumulation
NADH induces glycerol 3 phosphate = increase in triglycerides = fatty liver
increased fatty liver - ROS FORMATION
and kipper cells increase - staetohepatits
alcohol directly affect stellar cells = collagen producing myefibroblast cells
this leads to cirrhosis
what is the diagnosis for reversible alcoholic fatty liver ?
non megaloblastic macrocytic anemia = NOT FROM folic acid and vit b12 deficiency
ultrasound
↑ Liver echogenicity because of steatosis
CT: ↓ liver attenuation
==========
AST AND ALT ratio = more than 1
they both rise
ggt increase
ap and bilirubin = normal
liver biopsy = steatosis
what is dd of reversible fatty liver
non alcoholic liver disease
drug induced liver disease
wilson disease
what is the diagnostics of stateohepatitis ?
us
diffuse increase liver echo
ct decrease liver attenuation
us fibroscan
=========
AST to ALT (usually normal) ratio over 2
increase in ALP and GGT
hyperbilirubineia and prothrombin time
decrease in albumin
=========== biopsy ballooning degeneration of hepatocytes Mallory bodies fibrosis
what should be the treatment in fatty liver ?
only therapy = abstinence of alcohol
nutritional supplement
what should be the treatment in steatohepatitis
alcohol abstiene
only if in severe cases = prrednisolone
how much should the alcohol consumption be to give risk ?
men = 60-80g a day for 10 yrs
women 20-40g /day for 10 years
and alcoholic cirrhosis only develops in 20 percent in heavy drinkers
for treatment prognosis of alcoholic hepatitis what do we use ?
PT and bilirubin colerrate to severity
discriminant function
4.6 x (prolong of PTs) + bilirubin
value of over 32 poor prognosis
========
Glasgow alcohol hepatitis score age WBC urea PT bilirubin
more than 9 is poor porgnosis
======
MELD score
