Alcohol Hepatis Flashcards

1
Q

def

A

inflammatory liver injury due to chronic heavy intake of alcohol

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2
Q

aetiology

A

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
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3
Q

epi

A

10-35% of heavy drinkers develop this

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4
Q

history

A

history of heavy alcohol intake

may be asymptomatic
mild
-nausea
-malaise & fever
-epigastric or RUQ pain
severe
-jaundice
-swollen ankles
-Gi bleeding
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5
Q

examination

A
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
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6
Q

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

A

the liver metabolises oestrogen

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

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7
Q

investigations

A

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

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8
Q

what is the most sensitive marker of liver damage

A

prolonged PT

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9
Q

management

A

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

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10
Q

how would you treat encephalopathy

A

oral lactulose

phosphate enemas

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11
Q

what is the difference between enteral & parenteral feeding

A

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

parenteral does not involve the GI system (veins)

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12
Q

complications

A

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

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13
Q

what is acute liver decompensation

A

development of jaundice
ascites
variceal haemorrhage
hepatic encephalopathy

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14
Q

prognosis

A

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

if alcohol intake continues most progress to cirrhosis within 3yrs

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15
Q

what is maddreys discriminant function

A

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

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16
Q

what is the glasgow alcoholic hepatitis score

A

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

17
Q

how does the liver metabolise alcohol

A

alcohol dehydrogenase

cytochrome P450

18
Q

how do alcohol dehydrogenase and cytochrome P450 cause ALD

A

they are upregulated with chronic alcohol use

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