Alcohol and the liver

Question 1

Role of liver in carb metabolism?

Answer 1

• Excess glucose – glycogenesis (storage)
• Low blood glucose – glycogenolysis to provide more

Question 2

Role of liver in fat metabolism?

Answer 2

• Lipid metabolism predominantly within the liver
• Breaks down fats to produce phospholipids and cholesterol

Question 3

Role of liver in protein metabolism?

Answer 3

• Deamination (break down) and Transamination (make up) of amino acids
• Byproduct is Ammonia – liver synthesises urea to remove
• Albumin synthesis (main protein of blood plasma) almost exclusive to the liver

Question 4

What things are stored by the liver?

Answer 4

• Glucose, Iron, Copper, Vitamins

Question 5

Role of synthesis of liver?

Answer 5

• Fibrinogen (to Fibrin for clotting)
• Thrombopeitin (platelet production in bone marrow)

Question 6

How does the liver process alcohol?

Answer 6

• Consumption of alcohol
• Absorption into blood from mouth, oesophagus, stomach and intestines
• Blood arrives at liver
• Alcohol – Acetylaldehyde – Acetate
• Enzymes: ADH and ALDH
• Acetate converted to fatty acids, C20 and H20

Question 7

How many units per hour can healthy liver process?

Answer 7

1 unit per hour

Question 8

What happens when we overload the system?

Answer 8

Acetaldehyde is produced (carcinogen)

Question 9

How much is too much?

Answer 9

• < 14 units per week
• Male = Female
• ‘Keep health risks at a low level’
• Regular consumption – spread over >3 days
• >100 units per week 20% develop serious liver disease

Question 10

What factors predispose us to liver damage from alcohol?

Answer 10

• Poor dietary status – nutritional deficiencies
• Simultaneous exposure to other drugs (affects metabolism)
• Genetic variations/polymorphisms of enzymes
  
  • Fast acting ADH or slow acting ALDH (build up of acetaldehyde)
  • Dependence and progression
• Female gender more vulnerable
• Coexisting viruses eg hepatitis C (present with cirrhosis much earlier)

Question 11

Recent epidemiology?

Answer 11

• 500% increase over 20 year period of liver disease and mortality
• More than a third of cirrhosis are due to alcohol, and majority of deaths due to alcohol
• Mean age of death 50s

Question 12

What is the progression of alcohol related liver disease?

Answer 12

Normal - steatosis (fatty liver) - steatohepatitis - fibrosis - liver cirrhosis

Question 13

How does fatty liver arrise?

Answer 13

• Alcohol – acetaldehyde – acetate – fatty acids
• Alcohol is calorie rich
• Fat deposited around central veins then parenchyma
• Abstain from alcohol – liver returns to normal

Question 14

What are indicators of chronic alcohol use?

Answer 14

• Elevated gamma GT (liver enzyme)
• Macrocytosis (large red blood cells)
• Low platelets
• Elevated ferritin
• Enlarged smooth edged liver on AUSS

Question 15

What is alcoholic hepatitis and what does it result in?

Answer 15

• Fatty change within the liver
• And
  
  • Infiltration with leucocytes
  • Hepatic necrosis
• Results in
  
  • Hepatomegaly
  • Jaundice
  • Abdominal Pain
  • Fever
  • Hepatic decompensation
• May or may not be cirrhotic

Question 16

What is the criteria for alcoholic hepatitis?

Answer 16

Glasgow Alcoholic Hepatitis Score (28 day survival)

Question 17

What is liver fibrosis?

Answer 17

• Localised fibrosis around vein
• Collagen bridging between veins/tracts
• Loss of lobule structure

Increase in collagen scarring, cirrhosis is a more collagenic liver.

Question 18

What are complications of cirrhosis?

Answer 18

• Variceal haemorrhage
• Encephalopathy
• Ascites

Question 19

What is notable about hepatocellular carcinoma?

Answer 19

Rising incidence and mortality

Question 20

Is it worth abstaining if you are cirrhotic?

Answer 20

YES