3. Alcoholic Liver Disease

Question 1

What causes alcoholic liver disease?

Answer 1

Long term excessive consumption of alcohol

Question 2

How does alcoholic liver disease progress?

Answer 2

1. Alcohol related fatty liver
2. Alcoholic hepatitis
3. Cirrhosis

Question 3

What is alcohol related fatty liver?

Answer 3

Drinking leads to a build-up of fat in the liver. If drinking stops this process reverses in around 2 weeks.

Question 4

How can you reverse alcohol related fatty liver?

Answer 4

The process starts to reverses after you stop drinking for 2 weeks.

Question 5

What is alcoholic hepatitis? What causes it? How severe is it?

Answer 5

This is inflammation of the liver and can cause partial fibrosis.

It typically occurs in someone with alcohol related fatty liver who carries on to drink, but can occur in those with a healthy liver who have a severe episode of binge drinking.

If the episode is severe enough, you can skip out the next step (cirrhosis) and have death straight away.

Question 6

How can you reverse the effects of alcoholic hepatitis?

Answer 6

Permanent abstinence of alcohol

Question 7

What is cirrhosis?

Answer 7

This is where the liver is made up of scar tissue rather than healthy liver tissue.

Question 8

How can you reverse the effects of cirrhosis?

Answer 8

Cirrhosis is irreversible, although stopping drinking alcohol can prevent further damage. Continued drinking has a very poor prognosis.

Question 9

What are the signs of liver disease?

Answer 9

• Jaundice
• Hepatomegaly
• Spider Naevi
• Palmar Erythema - palms of hands are red
• Gynaecomastia
• Bruising – due to abnormal clotting
• Ascites
• Caput Medusae – engorged superficial epigastric veins
• Asterixis – “flapping tremor” in decompensated liver disease

Question 10

Which marker is used to assess whether someone has been drinking?

Answer 10

gamma-GT will go up if someone has been drinking

Question 11

When do NICE recommend a liver biopsy?

Answer 11

When steroid treatment is being considered

Question 12

How can alcoholic liver disease be treated?

Answer 12

• Stop drinking alcohol permanently
• Consider a detoxification regime
• Nutritional support with vitamins (particularly thiamine) and a high protein diet
• Steroids improve short term outcomes (over 1 month) in severe alcoholic hepatitis but infection and GI bleeding need to be treated first and do not improve outcomes over the long term
• Treat complications of cirrhosis (portal hypertension, varices, ascites and hepatic encephalopathy)
• Referral for liver transplant in severe disease however they must abstain from alcohol for 3 months prior to referral