Alcohol and the liver Flashcards
How does alcohol affect the liver?
Can be normal
Fatty liver
Alcoholic hepatitis
Cirrhosis
How does alcohol affect the CNS?
Self neglect ↓memory/cognition cortical atrophy fits falls neuropathy Wernicke-Korsakoff syndrome
How does alcohol affect the gut?
Obesity D+V Gastric erosions Peptic ulcers Varices Pancreatitis Cancer Oesophageal rupture
How does alcohol affect blood?
↑MCV anaemia from: - marrow depression - GI bleed - Alcoholism folate deficiency - haemolytic
How does alcohol affect the heart?
Arrhythmias
HTN
cardiomyopathy
sudden death in binge drinkers
How does alcohol affect the reproductive system?
testicular atrophy
↓testosterone/progesterone; ↑oestrogen; fetal alcohol syndrome
What are the features of fetal alcohol syndrome?
↓IQ
short palpebral fissure
absent philtrum
small eyes
What is seen on biopsy in cirrhosis?
mallory bodies
neutrophil infiltrate
What changes in LFTs may be seen due to alcohol?
raised GGT (can be raised in any type of liver inflammation)
what can fatty liver progress to if drinking continues?
cirrhosis
How does a patient w alcoholic hepatitis present?
malaise anorexia D+V tender hepatomegaly +/- jaundice bleeding ascites Raised TPR (temp, pulse, rests)
What may u see on blood tests in alcoholic hepatitis?
↑WCC ↓platelets (toxic effect or ∵ hypersplenism) ↑INR ↑AST ↑MCV ↑urea
What indicates a severe hepatitis?
jaundice
encephalopathy
coagulopathy
What is involved in the management of alcoholic hepatitis?
Hospitalise - catheter, CVP monitoring Infection? ascitic fluid tap + SBP Stop alcohol, rx withdrawal Vitamins: vit K + thiamine Give protein to prevent encephalopathy and sepsis Steroids if severe
What are the signs of alcohol withdrawal?
↑Pulse ↓BP tremor confusion fits delirium tremens (formication)
