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GI > Alcohol and Liver disease > Flashcards

Alcohol and Liver disease Flashcards

1
Q

What is the advice for pregnant women regarding alcohol?

A

Aviod

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2
Q

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

A

Increase in alcoholic liver disease

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3
Q

Which demographic has the highest alcohol related deaths?

A

Young men

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4
Q

What percentage of dealths in scotland are attributed to lcohol?

A

5%

This rises to 10% of deaths in men under 65

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5
Q

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

A

Scotland

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6
Q

In 2009 what percentage of hospital admissions were alcohol related?

A

5%

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7
Q

What is alcoholic liver disease?

A

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

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8
Q

What percentage of deaths from cirrhosis are due to alcohol?

A

85%

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9
Q

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

A

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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10
Q

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

A

Drowsiness, accidents, violence

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11
Q

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

A

Oesophagitis, gastritis, ulceration

Acute pancreatitis

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12
Q

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

A

Overdose

Aspiration

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13
Q

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

A

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

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14
Q

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

A

Neuropathies
Cerebellar degeneration
Dementia
Wernicke-Korsakoff’s syndrome

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15
Q

What causes Wernicke-Korsakoff’s syndrome?

A

Thymine deficiency

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16
Q

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

A

Hypertension
Cardiomyopathy
MI
Stroke

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17
Q

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

A

Atrophy of the brain

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18
Q

What are the effects of underage drinking on the brain?

A

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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19
Q

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

A

Proximal myopathy

Osteoporosis

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20
Q

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

A

Anaemia

Bone marrow suppression => immunodefficiency

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21
Q

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

A

Reduction in sperm production and a reduction in overall fertility

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22
Q

What is foetal alcohol syndrome?

A

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.

23
Q

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

A 
Microcephaly (small head)
Low nasal bridge
Short nose
Thin upper lip
Small chin
Low set ears 
Flat midface
Indistinct philtrum
24
Q

What are the 2 main enzymes involved in alcohol metabolism?

A

Alcohol dehydrogenase

Aldhehyde dehydrogenase

25
Q

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

A

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

26
Q

How is alcohol metabolised?

A

Ethanol –> Acetaldehyde (cytoplasm)

Acetaldehyde –> Acetate (mitochondria)

27
Q

How does alcohol lead to inflammation of the liver?

A

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

28
Q

How does alcohol lead to hepatocyte injury?

A

Acetaldehyde causes hepatocyte injury as the ethanol is metabolised

29
Q

How does alcohol cause fibrosis of the liver?

A

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

30
Q

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

A

Malnutrition

31
Q

What are the characteristics of alcoholic hepatitis?

A

Inflammation and hepatocyte injury leading to fibrosis

32
Q

What percentage of alcoholics develop Steatosis?

A

Steatosis is fatty liver disease.

90-100% of alcoholics will get this.

33
Q

Is steatosis reversible?

A

Yes

34
Q

What percentage of alcoholics with steatosis will get cirrhosis?

A

Up to 20%

35
Q

Is cirrhosis reversible?

A

No

36
Q

What percentage of those with Steatosis will develop alcoholic hepatitis?

A

Up to 35%

37
Q

Is alcoholic hepatitis reversible?

A

Yes

38
Q

What percentage of those with alcoholic hepatitis will develop cirrhosis?

A

70%

39
Q

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

A

Women- more cirrhosis at a lower dose of alcohol.

40
Q

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

A

True- malnutrition, genetics ect

41
Q

What arethe symptoms of alcoholic hepatitis?

A

Nausea, hepatomegaly, fever, jaundice

42
Q

What are the symptoms of severe alcoholic liver disease?

A

Sepsis, Encephalopathy, Ascites, Renal failure

43
Q

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

A

Yes, even in severe cases

44
Q

What are the signs of chronic liver disease?

A 
Spider navi, encephalopathy.
Low albumin- synthetic dysfunction
Prolonged prothrombin time
Portal hypertension (caut medusa, hypersplenism, thromboctopenia)
45
Q

How is liver cirrhosis graded?

A

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

46
Q

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

A

MELD score:

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

47
Q

What are the essential features when diagnosing alcoholic hepatitis?

A

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

48
Q

Do you biopsy for alcoholic hepatitis?

A

No- clinical diagnosis

49
Q

How is the prognosis of alcoholic hepatitis calculated?

A

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.

50
Q

How is alcoholic hepatitis treated?

A

Steroids have a short term survival benefit.

STOPAH trail showed PTX (pentoxifyline) has no benefit

51
Q

What is hepato renal syndrome?

A

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

52
Q

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

A

True

53
Q

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

A

True. The opposite is true in the long term.

54
Q

What are the benefits for 50p minimum unit pricing?

A

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

GI (48 decks)

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