Alcohol Liver Disease Flashcards
What is the spectrum of ALD? (3 things)
- Alcoholic Steatosis (Fatty Liver) (Reversible)
- Alcoholic Hepatitis (Inflamm Fatty Liver) (Can be Reversible)
- Cirrhosis (Irreversible)
(Can progress from 1-3)
What are all disorders in ALD secondary to?
Chronic alcohol abuse
What is alcohol metabolized to?
Acetaldehyde
What is Acetaldehyde? (3 things)
- Highly reactive toxic metabolite
- Carcinogen
- Accum contributes to oxidative liver damage
What are the pathways that metabolize alcohol? (2 things)
- Alcohol dehydrogenase
2. Cytochrome P450
Which of the 2 alcohol metabolism pathways can be upregulated when there is high alcohol consumption?
Cytochrome P450
What causes Triglycerides to accum in liver in Alcoholic Steatosis (Fatty Liver)? (3 things)
- Reduced liver fatty acid oxidation –> reduced fat export
- Increased peripheral lipolysis –> increased input of lipids to hepatic tissue
- Increased Triglyceride synthesis –> increased input of lipids to hepatic tissue
(all dis reversible tho bc dis only first stage of ALD liver clartation)
What is the pathophysiology of Alcoholic Hepatitis? (3 things)
- Steatosis
- Inflamm
- Regions of liver necrosis
What happens in Cirrhosis? (2 things)
- Fibrogenesis
2. Scarring of liver
What causes Fibrogenesis + Scarring of liver in Cirrhosis? (2 things)
- Hepatic tissue inflamm
2. Degeneration + Regeneration
What is existing liver tissue replaced by in Cirrhosis? (2 things)
- ECM
2. Collagen
What does the liver tissue replacement in Cirrhosis cause? (2 things)
- Reduced functional capacity of liver
2. Micronodules in liver
What are the CF of Alcoholic Steatosis? (Fatty Liver)? (3 things)
- Asymptomatic
- Maybe vague abd discomfort
- Hepatomegaly @ exam
What are the CF of Alcoholic Hepatitis? (8 things)
- Low grade Fever
- Lethargy + Confusion (bc hepatic encephalopathy)
- Nausea
- Jaundice
- Loss of appetite
- RUQ discomfort
- Hepatomegaly
- Ascites
(Head to toe)
What are the CF of Cirrhosis? (14 things)
- Alopecia
- Fatigue
- Lethargy + Confusion + Coma (bc hepatic encephalopathy)
- Jaundice
- Upper GI bleeding (bc portal HTN –> oesophageal varices)
- Asterixis (hand flap) (bc hepatic encephalopathy)
- Palmar erythema (red palms)
- Clubbed nails
- Dupuytren’s Contracture (flexion deformity of fingers bc thickening + shortening of palmar fascia)
- Pruritis (bc salt deposition in skin)
- Caput medusae (periumbilical vein dilation)
- Spider naevi
- Ascites (bc portal HTN + low albumin)
- Weight loss
- Hyperoestrogenism (gynecomastia / erectile dysf / infertility)
(Head to toe)
What investigations should you do for sus ALD? (5 things)
- Bloods
- US
- Endoscopy
- CT / MRI
- Liver biopsy
What bloods should you do in sus ALD? (4 things)
- FBC
- LFTs
- Clotting
- UnEs
What will FBC show you in ALD?
Raised MCV (RBC size)
What will LFTs show you in ALD? (5 things)
- Raised ALT + AST
- Raised gamma-GT
- Raised ALP (late in disease)
- Low albumin (bc reduced synthetic function of liver)
- Raised bilirubin (cirrhosis)
What will Clotting show you in ALD?
Elevated prothrombin time (bc reduced synthetic function of liver)
What may a US of liver show in ALD? (2 things)
- Fatty changes
2. Reduced elasticity (FibroScan US) (shows degree of cirrhosis)
When should you do an Endoscopy in ALD?
When sus Portal HTN
What would an Endoscopy show in ALD?
Oesophageal varices (if portal HTN)
Apart from seeing Oesophageal varices in ALD, what else is an endoscopy useful for?
Even treating da oesophageal varices
What can you see in a CT / MRI of liver in ALD? (5 things)
- Fatty infiltration of liver
- Hepatosplenomegaly
- Abn blood vessel changes
- Ascites
- Hepatocellular carcinoma
What patients does NICE recommend doing a liver biopsy for in ALD?
Patients where steroid treatment being considered
What is a liver biopsy used for in ALD?
Confirm Alcoholic Hepatitis / Cirrhosis diagnosis
What is the management for ALD? (5 things)
- X Alcohol 6awali
- High vit + prot diet
- Steroids (for short term improvement in Alcoholic Hepatitis)
- Treat cirrhosis complications (portal HTN / varcies / ascites / h. encephalopathy)
- Liver transplant referral (severe disease)
What need to be treated first before Steroids can be given in ALD? (2 things)
- Infection
2. GI Bleeding
How long must patients abstain from alcohol to be referred for liver transplants?
3 months
What should be given to treat alcohol withdrawal symptoms?
Benzodiazepines (e.g Chlordiazepoxide)
What are the complications of ALD? (4 things)
- Hepatic encephalopathy
- Portal HTN
- Hepato-renal syndrome
- Hepatocellular carcinoma
Why does Hepatic encephalopathy occur bc of ALD?
Bc build up of ammonia
What are the CF of Hepatic encephalopathy? (5 things)
- Confusion / Coma
- Drowsiness
- Fetor hepaticus (strong musty breath smell)
- Hyperventilation
- Asterixis
How should Hepatic encephalopathy be managed?
Lactulose
I’d like-to-lose dis encephalopathy
When do you get Portal HTN in ALD?
Once Cirrhosis established
Rarely in Alcoholic Hepatitis
