3.10. Liver + Biliary Tree Disease - Alcoholic Liver Disease Flashcards
What is the cause of Alcoholic Liver Disease?
Excessive Alcohol Consumption
Is Alcoholic Liver Disease more common in Males or Females?
Males
Where is Alcoholic Liver Disease most commonly found?
In the West, but prevalence is rising East Asia (potentially Genetic Predisposition there)
What is the action of Alcohol in the Liver?
This enhances the effects of Toxic Metabolites (of Drugs) on the Liver
By how many pathways is Ethanol (Alcohol) metabolized in the Liver?
2
What does the metabolism of Ethanol (Alcohol) result in?
An increase in the NADH / NAD ratio
What does the altered Redox Potential (caused by Ethanol (Alcohol) metabolism) result in, with regards to Fatty Acids?
- An increase in Hepatic Fatty Acid Synthesis
2. A decrease in Fatty Acid Oxidation
What does the altered Redox Potential (caused by Ethanol (Alcohol) metabolism) result in, with regards to Carbohydrate and Protein Metabolism?
Carbohydrate and Protein Metabolism are impaired
What does the impaired Carbohydrate and Protein Metabolism cause?
Centrilobular Necrosis of the Hepatic Acini
What are the 3 stages which occur due to the Increased Synthesis of Hepatic Fatty Acids?
- Fatty Change
- Alcoholic Hepatitis
- Alcoholic Cirrhosis
What is the Pathology of “Stage 1 - The Fatty Change”?
Hepatocytes become swollen with Fat / Fatty Acids (Steatosis)
In which hepatocytes are the Fat / Fatty Acids produced most?
The Hepatocytes furthest from the Vascular Supply / Closest to the Central Veins
Is there hepatocyte damage in “Stage 1 - The Fatty Change”?
No
What will happen upon Alcohol Cessation in “Stage 1 - The Fatty Change”?
The Fat / Fatty Acids will be dealt with and disappear
What is the Pathology of “Stage 2 - Alcoholic Hepatitis”?
In addition to the Fatty Change (in Stage 1) there is an infiltration of Leucocytes, which leads to Hepatocyte Necrosis
What does the Alcoholic Damage do in “Stage 2 - Alcoholic Hepatitis”?
It produces Mallory Bodies (Dense Cytoplasmic Inclusions) and Giant Mitochondria
What will happen if the consumption of Alcohol continues in Alcoholic Hepatitis?
- Hepatic Fibrosis
2. Hepatic (Alcoholic) Cirrhosis
What is the Pathology of “Stage 3 - Alcoholic Cirrhosis”?
Due to the Fibrosis and Hepatic Necrosis, caused in Alcoholic Hepatitis, the Hepatocytes die off
How does Alcoholic Cirrhosis present on the Liver?
It is classically Micronodular, but a mixed pattern is also seen accompanying fatty change
Can the Fatty Change (In Stage 1) jump straight to Alcoholic Cirrhosis (Stage 3)? And if so, what is the Pathology?
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)
What are the Clinical Features of Stage 1 - The Fatty Change in Alcoholic Hepatitis?
- None - Asymptomatic
- Nausea and Vomiting
- Diarrhoea
- Hepatomegaly
In addition to Stage 1 - The Fatty Change, what are other the Clinical Features of Stage 2 - Alcoholic Hepatitis?
- Chronic Liver Disease Signs
- Deranged Liver Biochemistry
- Jaundice
- Ascites with Ankle Oedema
- Frequent Abdominal Pain
- High Fever
In addition to Stage 2 - Alcoholic Hepatitis, what are other the Clinical Features of Stage 3 - Alcoholic Cirrhosis?
- The Complications of Cirrhosis
- Alcohol Dependency
- Polyneuropathy
What are the Clinical Features in Stage 1 - The Fatty Change all put down to?
The general effect of Alcohol on the Alimentary Tract
What can occur alongside Hepatomegaly?
Splenomegaly
What is the High Fever associated with?
Hepatic Necrosis
What investigations are required in Alcoholic Hepatitis?
- Abdominal Ultrasound
- CT Scan
- Liver Function Test (and Biochemistry)
What is the purpose of the Ultrasound / CT Scan?
To visualize the liver
What is being looked at in the Liver Function Test (and Biochemistry)?
Liver Function Test:
- Serum Albumin
- Prothrombin Time
Liver Biochemistry:
- Serum Bilirubin
- Alkaline Phosphatase
- Gamma-Glutamyl Transpeptidase
- Aminotransferase:
a) Aspartate Aminotransferase
b) Alanine Aminotransferase
What will be found on the Liver Function Test in “Stage 1- The Fatty Change” in Alcoholic Hepatitis?
This will be Slightly Abnormal:
Aminotransferase Elevation
What will be found on the Liver Function Test in “Stage 2/3 - Alcoholic Hepatitis/Cirrhosis”?
- Low Serum Albumin
- Elevated Prothrombin Time
- Hyperbilirubinaemia
- Elevated Alkaline Phosphatase
- Elevated Gamma-Glutamyl Transpeptidase
- Elevated Aspartate Aminotransferase
- Elevated Alanine Aminotransferase
What is the Treatment of “Stage 1 - The Fatty Liver Change” in Alcoholic Hepatitis?
- Alcohol Cessation
- Diazepam
- I.V. Thiamine
- Bed Rest
- Nutrient Support
In addition to the Treatment of “Stage 1 - The Fatty Change”, what other treatments would be introduced in “Stage 2 - Alcoholic Hepatitis”?
- Infection Treatment
- Steroid Therapy
- Diuretics / Paracentesis
- Antifungal Prophylaxis
What is the only cure for “Stage 3 - Alcoholic Cirrhosis”?
A Transplant
What is the function of Diazepam?
To control the Alcohol withdrawal symptoms
What is the funtion of I.V. Thiamine?
To prevent Encephalopathy
What is the purpose of keeping the patient on Bed Rest?
So they can be monitored
Why is Nutrient Supplementation required?
Due to the patient usually being malnourished
What Nutrients are usually needing supplemented?
Protein and Vitamins
Why is Infection Treatment needed as part of Alcoholic Hepatitis?
As Viral Hepatitis must be excluded as the cause
What does the Steroid Therapy do?
This improves the short term prognosis
What Score is used to indicate if steroids are necessary?
The Glasgow Alcoholic Hepatitis Score
What is taken into account in the Glasgow Alcoholic Hepatitis Score?
- Age (Years)
- White Blood Cell Count
- Urea (mmol/L)
- Prothrombin Time / International Normalized Ratio
- Serum Bilirubin (μmol/L)
What is the Glasgow Alcoholic Hepatitis Score out of?
12
At what score is there a significant risk of Death?
9 or more
What is the Age Component of the Glasgow Alcoholic Hepatitis Score divided into?
Less than 50 years old = Scores 1
Older than 50 years old = Scores 2
What is the WCC Component of the Glasgow Alcoholic Hepatitis Score divided into?
Less than 15x10^9 = Scores 1
More than 15x10^9 = Scores 2
What is the PT / INR Component of the Glasgow Alcoholic Hepatitis Score divided into?
Less than 1.5 = Scores 1
Between 1.5-2.0 = Scores 2
More than 2.0 = Scores 3
What is the Bilirubin Component of the Glasgow Alcoholic Hepatitis Score divided into?
Less than 125μmol/L = Scores 1
Between 125-250μmol/L = Scores 2
More than 250μmol/L = Scores 3
What is the Urea Component of the Glasgow Alcoholic Hepatitis Score divided into?
Less than 5mmol/L = Scores 1
More than 5mmol/L = Scores 2
