Alcohol Hepatis Flashcards
def
inflammatory liver injury due to chronic heavy intake of alcohol
aetiology
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
epi
10-35% of heavy drinkers develop this
history
history of heavy alcohol intake
may be asymptomatic mild -nausea -malaise & fever -epigastric or RUQ pain severe -jaundice -swollen ankles -Gi bleeding
examination
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
why does liver disease cause palmar erythema, spider naevi, gynaecomastic
the liver metabolises oestrogen
with liver dysfunction there is failure to metabolise oestrogen therefore oestrogen levels rise
investigations
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
what is the most sensitive marker of liver damage
prolonged PT
management
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
how would you treat encephalopathy
oral lactulose
phosphate enemas
what is the difference between enteral & parenteral feeding
enteral involves the GI system (oral, sublingual, rectal)
parenteral does not involve the GI system (veins)
complications
-acute liver decompensation
-hepatorenal syndrome (renal failure secondary to advanced liver disease)
corrhosis
what is acute liver decompensation
development of jaundice
ascites
variceal haemorrhage
hepatic encephalopathy
prognosis
mortality in first month 10%
mortality in first year 40%
if alcohol intake continues most progress to cirrhosis within 3yrs
what is maddreys discriminant function
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