Alcohol Related Disease Flashcards by Abby McCabe

Diseases from what system have the greatest mortality compared to the rest?

Liver diseases

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Do woman or men metabolise alcohol slower?

Women

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What causes a variation in alcohol toxicity?

Genetic variation

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What is the pathway of ethanol metabolism?

Ethanol -> Acetaldehyde -> Acetate

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What enzyme converts ethanol into acetaldehyde?

Alcohol dehydrogenase

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What enzyme converts acetaldehyde into acetate?

Acetaldehyde dehydrogenase

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What effects does alcohol have on the liver?

Steatosis (fatty liver)

Steatohepatitis (fatty liver with inflammation)

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What does steatosis describe?

Process describing abnormal retention of lipids within a cell or organ

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What is steatohepatitis?

Type of fatty liver disease characterised by inflammation of the liver with concurrent fat accumulation in the liver

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What are causes of steatohepatitis?

Neutrophil infiltration

Fibrosis, cirrhosis (build up of scar tissue)

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When taking a history to do with alcohol liver disease what acrynm should be remembered?

CAGE:

Have you ever felt the need to CUT down

Have you been ANNOYED by criticism of your drinking

Have you felt GUILTY about your drinking

Do you need an EYEOPENER

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How much beer, wine and spirits is 1 unit of alcohol?

Half pint of beer

Small glass of wine

Single measure of spirit

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What questionaire is used to determine alcoholism?

FAST questionaire

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A score of what is FAST positive on a FAST questionaire?

3 or more

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What do you do if someone gets a score of 3 or more on a FAST questionaire?

Complete remaining audit questions to obtain a full AUDIT score

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When doing a full AUDIT score on a FAST questionaire, what is considered to be increasing risk, higher risk and possible dependence?

8-15 is increasing risk

16-19 is higher risk

20+ is possible dependence

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What are physical findings for alcoholic liver disease?

Majority have no physical findings until advanced liver disease

Signs of chronic liver disease (spider naevi, palmar erythema, gynaemocastia, loss of axillary and pubic hair, ascites, encephalopathy)

Jaundice

Muscle wasting

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What can be seen in lab tests for alcoholic liver disease?

Asparate amino transferase (AAT) > alanine amino transferase (ALT), ratio > 2

Raised gamma glutamyl transferase

Macrocytosis

Thrombocytopenia (low platelets)

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What imaging is done to look for a fatty liver?

Ultrasound scan

What is hepatic encephalopathy?

Decline in brain function that occurs due to severe liver disease

How is the severity of hepatic encephalopathy graded?

1 to 4

Where 1 is mild confusion and 4 is a coma

What is the aetiology of hepatic encephalopathy?

Infection

Drugs

Constipation

GI bleed

Electrolyte disturbance

What should be excluded before diagnosing hepatic encephalopathy?

Infection

Hypoglycaemia

Intra-cranial bleed

What is the treatment of hepatic encephalopathy?

Bowel clear out, lactulose, enemas Antibiotics Supportive (ITU, airway support, NG tube for meds)

What does SBP stand for?

Spontaneous bacterial peritonitis

What is spontaneous bacterial peritonitis (SBP)?

Development of bacterial infection in the peritoneum, despite the absence of obvious source for the infection

What are symptoms and signs of spontaneous bacterial peritonitis?

Abdominal pain Fever, rigors Renal impairment Signs of sepsis such as tachycardia and temperature

What investigations should be done for spontaneous bacterial peritonitis (SBP)?

Ascitic tap: fluid protein and glucose levels cultures white cell content

What is the neutrophil count for spontaneous bacterial peritonitis?

\> 0.25 x 10⁹/L

What is the protein level for spontaneous bacterial peritonitis?

\< 25g/L

What is the treatment of spontaneous bacterial peritonitis?

IV antibiotics Ascitic fluid drainage IV albumin infusion (20% ALBA)

What is alcoholic hepatitis?

Inflammation of the liver caused by drinking alcohol

What is the presentation of alcoholic hepatitis?

Jaundice Encephalopathy Infection common Decompensated hepatic function (low albumin and raised prothrombin time/INR)

What is required for a diagnosis of alcoholic hepatitis?

Raised bilirubin Raised GGT and AlkP Alcohol history Exclude other causes

What is the prognosis of alcoholic hepatitis like?

Poor 40% mortality If severe up to 90% mortality

What is the treatment for alcoholic hepatitis?

Supportive Treat infection Treat encephalopathy Treat alcohol withdrawal Protect against GI bleeding Airway protection/ITU care Steroids (only if graded severe, Glasgow alcoholic hepatitis score \> 9) Nutritional (they are malnourished, give thiamine)

What Glasgow alcoholic hepatitis score is required for steroids to be used as a treatment?

\> 9

What does the Glasgow Alcoholic Hepatitis score consider?

Age White cell count Urea INR Billirubin

Other than the Glasgow Alcoholic Hepatitis score, what is another way of evaluating the severity of alcoholic hepatitis?

Maddrey's discrimination function

What is the prognosis of alcoholic hepatitis dependent on?

Alcohol abstinence or ongoing consumption

What are the different kinds of fatty liver?

Steatosis (non-alcoholic fatty liver disease, NAFLD) Steatohepatitis (non-alcoholic steatohepatitis, NASH)

What does NAFLD stand for?

Non-alcohlic fatty liver disease

What does NASH stand for?

Non-alcoholic steatohepatitis

What are risk factors for fatty liver?

Obesity Diabetes Hypercholesterolaemia Alcohol

What percentage of people with fatty liver develop cirrhosis?

25%

What is the treatment for fatty liver?

Weight loss Exercise

What is required to diagnose fatty liver?

Raised alanine amino transferase Fatty liver on USS Liver biopsy