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Clinical Alimentary System > 3.10. Liver + Biliary Tree Disease - Alcoholic Liver Disease > Flashcards

3.10. Liver + Biliary Tree Disease - Alcoholic Liver Disease Flashcards

1
Q

What is the cause of Alcoholic Liver Disease?

A

Excessive Alcohol Consumption

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2
Q

Is Alcoholic Liver Disease more common in Males or Females?

A

Males

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3
Q

Where is Alcoholic Liver Disease most commonly found?

A

In the West, but prevalence is rising East Asia (potentially Genetic Predisposition there)

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4
Q

What is the action of Alcohol in the Liver?

A

This enhances the effects of Toxic Metabolites (of Drugs) on the Liver

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5
Q

By how many pathways is Ethanol (Alcohol) metabolized in the Liver?

A

2

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6
Q

What does the metabolism of Ethanol (Alcohol) result in?

A

An increase in the NADH / NAD ratio

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7
Q

What does the altered Redox Potential (caused by Ethanol (Alcohol) metabolism) result in, with regards to Fatty Acids?

A
  1. An increase in Hepatic Fatty Acid Synthesis

2. A decrease in Fatty Acid Oxidation

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8
Q

What does the altered Redox Potential (caused by Ethanol (Alcohol) metabolism) result in, with regards to Carbohydrate and Protein Metabolism?

A

Carbohydrate and Protein Metabolism are impaired

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9
Q

What does the impaired Carbohydrate and Protein Metabolism cause?

A

Centrilobular Necrosis of the Hepatic Acini

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10
Q

What are the 3 stages which occur due to the Increased Synthesis of Hepatic Fatty Acids?

A
  1. Fatty Change
  2. Alcoholic Hepatitis
  3. Alcoholic Cirrhosis
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11
Q

What is the Pathology of “Stage 1 - The Fatty Change”?

A

Hepatocytes become swollen with Fat / Fatty Acids (Steatosis)

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12
Q

In which hepatocytes are the Fat / Fatty Acids produced most?

A

The Hepatocytes furthest from the Vascular Supply / Closest to the Central Veins

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13
Q

Is there hepatocyte damage in “Stage 1 - The Fatty Change”?

A

No

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14
Q

What will happen upon Alcohol Cessation in “Stage 1 - The Fatty Change”?

A

The Fat / Fatty Acids will be dealt with and disappear

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15
Q

What is the Pathology of “Stage 2 - Alcoholic Hepatitis”?

A

In addition to the Fatty Change (in Stage 1) there is an infiltration of Leucocytes, which leads to Hepatocyte Necrosis

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16
Q

What does the Alcoholic Damage do in “Stage 2 - Alcoholic Hepatitis”?

A

It produces Mallory Bodies (Dense Cytoplasmic Inclusions) and Giant Mitochondria

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17
Q

What will happen if the consumption of Alcohol continues in Alcoholic Hepatitis?

A
  1. Hepatic Fibrosis

2. Hepatic (Alcoholic) Cirrhosis

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18
Q

What is the Pathology of “Stage 3 - Alcoholic Cirrhosis”?

A

Due to the Fibrosis and Hepatic Necrosis, caused in Alcoholic Hepatitis, the Hepatocytes die off

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19
Q

How does Alcoholic Cirrhosis present on the Liver?

A

It is classically Micronodular, but a mixed pattern is also seen accompanying fatty change

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20
Q

Can the Fatty Change (In Stage 1) jump straight to Alcoholic Cirrhosis (Stage 3)? And if so, what is the Pathology?

A

Yes, if Collagen is laid down around the Central Hepatic Vein (Perivenular Fibrosis) in Stage 1 this can lead directly to Hepatic Cirrhosis (Stage 3)

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21
Q

What are the Clinical Features of Stage 1 - The Fatty Change in Alcoholic Hepatitis?

A
  1. None - Asymptomatic
  2. Nausea and Vomiting
  3. Diarrhoea
  4. Hepatomegaly
22
Q

In addition to Stage 1 - The Fatty Change, what are other the Clinical Features of Stage 2 - Alcoholic Hepatitis?

A
  1. Chronic Liver Disease Signs
  2. Deranged Liver Biochemistry
  3. Jaundice
  4. Ascites with Ankle Oedema
  5. Frequent Abdominal Pain
  6. High Fever
23
Q

In addition to Stage 2 - Alcoholic Hepatitis, what are other the Clinical Features of Stage 3 - Alcoholic Cirrhosis?

A
  1. The Complications of Cirrhosis
  2. Alcohol Dependency
  3. Polyneuropathy
24
Q

What are the Clinical Features in Stage 1 - The Fatty Change all put down to?

A

The general effect of Alcohol on the Alimentary Tract

25
Q

What can occur alongside Hepatomegaly?

A

Splenomegaly

26
Q

What is the High Fever associated with?

A

Hepatic Necrosis

27
Q

What investigations are required in Alcoholic Hepatitis?

A
  1. Abdominal Ultrasound
  2. CT Scan
  3. Liver Function Test (and Biochemistry)
28
Q

What is the purpose of the Ultrasound / CT Scan?

A

To visualize the liver

29
Q

What is being looked at in the Liver Function Test (and Biochemistry)?

A

Liver Function Test:

  1. Serum Albumin
  2. Prothrombin Time

Liver Biochemistry:

  1. Serum Bilirubin
  2. Alkaline Phosphatase
  3. Gamma-Glutamyl Transpeptidase
  4. Aminotransferase:
    a) Aspartate Aminotransferase
    b) Alanine Aminotransferase
30
Q

What will be found on the Liver Function Test in “Stage 1- The Fatty Change” in Alcoholic Hepatitis?

A

This will be Slightly Abnormal:

Aminotransferase Elevation

31
Q

What will be found on the Liver Function Test in “Stage 2/3 - Alcoholic Hepatitis/Cirrhosis”?

A
  1. Low Serum Albumin
  2. Elevated Prothrombin Time
  3. Hyperbilirubinaemia
  4. Elevated Alkaline Phosphatase
  5. Elevated Gamma-Glutamyl Transpeptidase
  6. Elevated Aspartate Aminotransferase
  7. Elevated Alanine Aminotransferase
32
Q

What is the Treatment of “Stage 1 - The Fatty Liver Change” in Alcoholic Hepatitis?

A
  1. Alcohol Cessation
  2. Diazepam
  3. I.V. Thiamine
  4. Bed Rest
  5. Nutrient Support
33
Q

In addition to the Treatment of “Stage 1 - The Fatty Change”, what other treatments would be introduced in “Stage 2 - Alcoholic Hepatitis”?

A
  1. Infection Treatment
  2. Steroid Therapy
  3. Diuretics / Paracentesis
  4. Antifungal Prophylaxis
34
Q

What is the only cure for “Stage 3 - Alcoholic Cirrhosis”?

A

A Transplant

35
Q

What is the function of Diazepam?

A

To control the Alcohol withdrawal symptoms

36
Q

What is the funtion of I.V. Thiamine?

A

To prevent Encephalopathy

37
Q

What is the purpose of keeping the patient on Bed Rest?

A

So they can be monitored

38
Q

Why is Nutrient Supplementation required?

A

Due to the patient usually being malnourished

39
Q

What Nutrients are usually needing supplemented?

A

Protein and Vitamins

40
Q

Why is Infection Treatment needed as part of Alcoholic Hepatitis?

A

As Viral Hepatitis must be excluded as the cause

41
Q

What does the Steroid Therapy do?

A

This improves the short term prognosis

42
Q

What Score is used to indicate if steroids are necessary?

A

The Glasgow Alcoholic Hepatitis Score

43
Q

What is taken into account in the Glasgow Alcoholic Hepatitis Score?

A
  1. Age (Years)
  2. White Blood Cell Count
  3. Urea (mmol/L)
  4. Prothrombin Time / International Normalized Ratio
  5. Serum Bilirubin (μmol/L)
44
Q

What is the Glasgow Alcoholic Hepatitis Score out of?

A

12

45
Q

At what score is there a significant risk of Death?

A

9 or more

46
Q

What is the Age Component of the Glasgow Alcoholic Hepatitis Score divided into?

A

Less than 50 years old = Scores 1

Older than 50 years old = Scores 2

47
Q

What is the WCC Component of the Glasgow Alcoholic Hepatitis Score divided into?

A

Less than 15x10^9 = Scores 1

More than 15x10^9 = Scores 2

48
Q

What is the PT / INR Component of the Glasgow Alcoholic Hepatitis Score divided into?

A

Less than 1.5 = Scores 1
Between 1.5-2.0 = Scores 2
More than 2.0 = Scores 3

49
Q

What is the Bilirubin Component of the Glasgow Alcoholic Hepatitis Score divided into?

A

Less than 125μmol/L = Scores 1
Between 125-250μmol/L = Scores 2
More than 250μmol/L = Scores 3

50
Q

What is the Urea Component of the Glasgow Alcoholic Hepatitis Score divided into?

A

Less than 5mmol/L = Scores 1

More than 5mmol/L = Scores 2

Clinical Alimentary System (64 decks)

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