Alcohol Hepatis

Question 1

def

Answer 1

inflammatory liver injury due to chronic heavy intake of alcohol

Question 2

aetiology

Answer 2

one of three forms of liver disease caused by excessive alcohol intake
1 alcoholic fatty liver (steatosis)
2 alcoholic hepatitis
3 chronic cirrhosis

in alcoholic hepatitis liver histopathology shows

• centrilobular ballooning degeneration
• necrosis of hepatocytes

Question 3

epi

Answer 3

10-35% of heavy drinkers develop this

Question 4

history

Answer 4

history of heavy alcohol intake

may be asymptomatic
mild
-nausea
-malaise & fever
-epigastric or RUQ pain
severe
-jaundice
-swollen ankles
-Gi bleeding

Question 5

examination

Answer 5

signs of alcohol excess
-malnourished
-palmar erythema, spider naevi & gynaecomastia
-dupuytrens contracture
-facial telangiectasia
-parotid enlargement
signs of severe alcoholic hepatitis
-febrile
-tachycardia
-jaundice
-encephalopathy (hepatic flap)
-ascites
-hepatomegaly

Question 6

why does liver disease cause palmar erythema, spider naevi, gynaecomastic

Answer 6

the liver metabolises oestrogen

with liver dysfunction there is failure to metabolise oestrogen therefore oestrogen levels rise

Question 7

investigations

Answer 7

1 bloods
-FBC (low Hb, high MCV, high WCC, low platelets)
-LFTs (high transminases, high bilirubin, low albumin)
-prolonged PT
2 USS for exclusion
3 upper GI endoscopy to exclude varices
4 liver biopsy to distinguish cause of hepatitis

Question 8

what is the most sensitive marker of liver damage

Answer 8

prolonged PT

Question 9

management

Answer 9

acute
-thiamine, Vit C & other multivitamins
-monitor & correct K, Mg, glucose
-treat encephalopathy
-treat ascites with diuretics (spironolactone +/ furosemide)
nutrition
-increased caloric intake
-protein restriction avoided unless encephalopathic
steroid therapy
-reduce short-term mortality for severe alcoholic hepatitis

Question 10

how would you treat encephalopathy

Answer 10

oral lactulose

phosphate enemas

Question 11

what is the difference between enteral & parenteral feeding

Answer 11

enteral involves the GI system (oral, sublingual, rectal)

parenteral does not involve the GI system (veins)

Question 12

complications

Answer 12

-acute liver decompensation
-hepatorenal syndrome (renal failure secondary to advanced liver disease)
corrhosis

Question 13

what is acute liver decompensation

Answer 13

development of jaundice
ascites
variceal haemorrhage
hepatic encephalopathy

Question 14

prognosis

Answer 14

mortality in first month 10%
mortality in first year 40%

if alcohol intake continues most progress to cirrhosis within 3yrs

Question 15

what is maddreys discriminant function

Answer 15

a prognostic score for alcoholic hepatitis

MDF = (bilirubin/17) + (prolongation of PT * 4.6)

if MDF >32 indicates there is a >50% 30 day mortality

Question 16

what is the glasgow alcoholic hepatitis score

Answer 16

GAHS is a prognostic score for alcoholic hepatitis

1 age
2 WCC
3 urea
4 PT ratio
5 bilirubin

if GAHS>9 indicates there is a 50% 30 day mortality

Question 17

how does the liver metabolise alcohol

Answer 17

alcohol dehydrogenase

cytochrome P450

Question 18

how do alcohol dehydrogenase and cytochrome P450 cause ALD

Answer 18

they are upregulated with chronic alcohol use

they generate free radicles and inhibit gluconeogenesis leading to infiltration of fat into the liver