Alcohol and Liver disease Flashcards by Anna Marshall

What is the advice for pregnant women regarding alcohol?

Aviod

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What caused the increase in liver mortality rates up to 2006 in scotland?

Increase in alcoholic liver disease

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Which demographic has the highest alcohol related deaths?

Young men

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What percentage of dealths in scotland are attributed to lcohol?

This rises to 10% of deaths in men under 65

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Which area of the UK has the highest alcohol related deaths?

Scotland

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In 2009 what percentage of hospital admissions were alcohol related?

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What is alcoholic liver disease?

Alcoholic liver disease includes fatty liver, alcoholic hepatitis, and chronic hepatitis with liver fibrosis or cirrhosis

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What percentage of deaths from cirrhosis are due to alcohol?

85%

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Between 1987 and 2006 there has been a 52% increase in hepatocellular carcinoma. Is deprivation a factor in mortality from cirrhosis?

Yes- those in the most deprived areas are more likely to die from cirrhosis. Risk is 6 times greater in the deprived area

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What are the acute effects of excess alcohol consumption on the CNS?

Drowsiness, accidents, violence

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What are the acute effects of excess alcohol consumption on the GI system?

Oesophagitis, gastritis, ulceration

Acute pancreatitis

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What are the acute effects of excess alcohol consumption on the respiratory system?

Overdose

Aspiration

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What are the chronic effects of consuming excess alcohol on the GI system?

Stomach (gastritis)
Liver (fatty liver disease, alcoholic hepatitis, Cirrhosis)
Pancreas (chronic pancreatitis)

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What are the chronic effects of consuming excess alcohol on the CNS?

Neuropathies
Cerebellar degeneration
Dementia
Wernicke-Korsakoff’s syndrome

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What causes Wernicke-Korsakoff’s syndrome?

Thymine deficiency

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What are the chronic effects of consuming excess alcohol on the CVS?

Hypertension
Cardiomyopathy
MI
Stroke

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What would you see on a CT brain of an alcoholic?

Atrophy of the brain

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What are the effects of underage drinking on the brain?

Underage drinking causes smaller hippocampal memory areas of the brain.
Teens with alcohol use disorders have greater activity in areas of the brain linked to: Reward, desire, positive effect and episodic recall in response to alcohol advertisements.

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What are the chronic effects of consuming excess alcohol on the MSK system?

Proximal myopathy

Osteoporosis

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What are the chronic effects of consuming excess alcohol on haematology?

Anaemia

Bone marrow suppression => immunodefficiency

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What are the chronic effects of consuming excess alcohol on the reproductive sustem?

Reduction in sperm production and a reduction in overall fertility

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What is foetal alcohol syndrome?

A condition which >10% of babies exposed to alcohol (usually 7-14 drinks per week, esp. binge drinking) in utero get. Characterised by growth deficiency, mental retardation/intellectual impairment, attention learning disabilities and behavioural problems.

What are the typical facial features of a baby with foetal alcohol syndrome?

Microcephaly (small head)
Low nasal bridge
Short nose
Thin upper lip
Small chin
Low set ears 
Flat midface
Indistinct philtrum

What are the 2 main enzymes involved in alcohol metabolism?

Alcohol dehydrogenase

Aldhehyde dehydrogenase

The body also has 2 tertialy pathways for alcohol metabolism other than the alcohol dehydrogenase pathway. Why is this?

If the main pathway becomes over loaded it tries to prevent alcohol toxicity

How is alcohol metabolised?

Ethanol --> Acetaldehyde (cytoplasm) | Acetaldehyde --> Acetate (mitochondria)

How does alcohol lead to inflammation of the liver?

Alcohol causes endotoxemia which activates Kupffer cells which realse TNF alpha that causes inflammation.

How does alcohol lead to hepatocyte injury?

Acetaldehyde causes hepatocyte injury as the ethanol is metabolised

How does alcohol cause fibrosis of the liver?

Oxidative stress due to alcohol activates sellate cells in the liver which leads to fibrosis

The liver can regenerate. What most commonly impairs this regeneration in alcoholics?

Malnutrition

What are the characteristics of alcoholic hepatitis?

Inflammation and hepatocyte injury leading to fibrosis

What percentage of alcoholics develop Steatosis?

Steatosis is fatty liver disease. | 90-100% of alcoholics will get this.

Is steatosis reversible?

Yes

What percentage of alcoholics with steatosis will get cirrhosis?

Up to 20%

Is cirrhosis reversible?

What percentage of those with Steatosis will develop alcoholic hepatitis?

Up to 35%

Is alcoholic hepatitis reversible?

Yes

What percentage of those with alcoholic hepatitis will develop cirrhosis?

70%

Which sex are much more susceptible to the effects of alcohol?

Women- more cirrhosis at a lower dose of alcohol.

The development of significant alcoholic liver disease is related to factors other than alcohol dose. T or F?

True- malnutrition, genetics ect

What arethe symptoms of alcoholic hepatitis?

Nausea, hepatomegaly, fever, jaundice

What are the symptoms of severe alcoholic liver disease?

Sepsis, Encephalopathy, Ascites, Renal failure

Reduction in alcohol consumption can slow the progression of liver disease?

Yes, even in severe cases

What are the signs of chronic liver disease?

``` Spider navi, encephalopathy. Low albumin- synthetic dysfunction Prolonged prothrombin time Portal hypertension (caut medusa, hypersplenism, thromboctopenia) ```

How is liver cirrhosis graded?

Child's Score A- Mild (5-6 = well compensated) B- Moderate (7-9 = significant functional compromise) C- severe (10-15 = decompensated)

What score is used to assess if a liver transplant is required?

MELD score: | Model for end stage liver disease. Assesses 3 month mortality from 6% up to 52%

What are the essential features when diagnosing alcoholic hepatitis?

Recent alcohol excess Bilirubin >80 (jaundiced) Exclusion of other liver disease AST <500 (AST:ALT ratio >1.5) Also can have- hepatomegaly, Fever, leucocytosis and hepatic bruit

Do you biopsy for alcoholic hepatitis?

No- clinical diagnosis

How is the prognosis of alcoholic hepatitis calculated?

Maddreys Discriminant function. Score >32 gives a 45% 4 week mortality but there are concerns with accuracy. Glasgow alcoholic hepatitis score <9 gives a 90% survival but >9 gives a 46% survival at 4 weeks.

How is alcoholic hepatitis treated?

Steroids have a short term survival benefit. | STOPAH trail showed PTX (pentoxifyline) has no benefit

What is hepato renal syndrome?

Life-threatening medical condition that consists of rapid deterioration in kidney function in individuals with cirrhosis or liver failure.

Stastically, the more severe your liver disease the more likely you are to stop drinking. T or F?

True

The prognosis in the short term is better for End Stage Liver Disease than alcoholic hepatitis. T of F?

True. The opposite is true in the long term.

What are the benefits for 50p minimum unit pricing?

Fewer deaths, fewer hospital admissions, fewer crimes, fewer sick days, saving for the economy