alcohol and liver disease

Question 1

hazardous vs harmful drinking

Answer 1

hazardous - drinking more than the recommended weekly allowance or in a risky manor
harmful - hazardous drinking with health/social problems directly related to alcohol

Question 2

what is dependent drinking

Answer 2

when a pt feels that they cannot function without drink

Question 3

signs of dependent drinking (5)

Answer 3

1. alcohol tolerance
2. withdrawal symptoms
3. unsuccessful attempts to cut drinking
4. loss of social/occupational pursuits
5. use despite knowledge of harm

Question 4

what is the major breakdown pathway for low levels of alcohol

Answer 4

ethanol –(alcohol dehydrogenase)–> acetaldehyde –(aldehyde dhydrogenase)–> acetate

Question 5

what is the major breakdown pathway for high serum levels of alcohol

Answer 5

microsomal ethanol oxidising system:
ethanol –(cytochrome P450 2E1)–> acetaldehyde –(aldehyde dehydrogenase)–> acetate

Question 6

what is a by product of the microsomal ethanol oxidising system that can cause harm to the liver

Answer 6

ROS

Question 7

what cells does the microsomal ethanol oxidising system take place in

Answer 7

hepatocytes and Kupfer cells (after chronic exposure)

Question 8

can people be genetically susceptible to alcholism/ALD

Answer 8

yes - defects in main alcohol metabolising receptors (e.g. CYPE2, alcohol dehydrogenase etc.) can lead to greater susceptibilty

Question 9

risk factors for alcohol liver disease

Answer 9

1. gender - being female increases risk)
2. genetic variability
3. nutrition
4. hepatitis virus
5. co-exposure to drugs/toxins
6. immunological derangement - MCH1/ DR2 antigens
7. development of antibodies to neo-antigens
8. haematochomatosis/alpha anti-tripsin 1

Question 10

why are women at a higher risk of alcohol liver disease (2)

Answer 10

1. lower levels of mucosal alcohol dehydrogenase
2. oestrogen levels correlate to liver damage

Question 11

why do alcohol withdrawal symptoms happen (biochem)

Answer 11

alcohol enhances the effect of GABA on GABA-A neuroreceptors, resulting in decreased overall brain excitability -> Chronic exposure to alcohol results in a compensatory decrease of GABA-A neuroreceptor response to GABA (evidenced by increasing tolerance of the effects of alcohol) -> Abrupt cessation of alcohol exposure results in brain hyperexcitability, because receptors previously inhibited by alcohol are no longer inhibited -> Brain hyperexcitability manifests clinically as anxiety, irritability, agitation, and tremors

Question 12

alcohol withrawal timeline stages (3)

Answer 12

1. anxiety, insomnia, nausea, abdominal pain (first 8hrs)
2. high blood pressure, increased body temp (1-3 days)
3. hallucinations, fever, seizures, agitation (1 wk)

Question 13

what nutrition deficiencies are associated w alcoholic liver disease

Answer 13

1. B complex vitamin deficiencies
2. vitamin A, D deficiencies
3. vit C deficiency
4. micronutrients (Se, Zn)

Question 14

is alcoholic liver disease treateble

Answer 14

yes - it is reversible with abstinence

Question 15

what other factors are essential for treating alcoholic liver disease other than abstience

Answer 15

1. good nutritional support
2. good psychological support/drugs support