Alcohol related disease

Question 1

metabolism of alcohol

Answer 1

Ethanol -> Acetaldehyde (toxic) -> Acetate

When conjested can lead to:
-excess fat
-hypoglycemia
-ketosis
-acidosis

Question 2

What is steatosis vs steatohepititis?

Answer 2

STeatosis = fat in liver cells
Steatohepititis = fat in liver cells -> INFLAMMATION

Question 3

CAGE questions

Answer 3

C- ut down (thought about)
A - Annoyed (at critisism of drinking)
G - Guilty (about drinking)
E - Eyeopener (needed it in the morning)

Question 4

What is the fast scoring sysytem?

Answer 4

An easy way to score how much alcohol a patient has drank based on easy calculations of units etc

Question 5

What are the signs of chronic liver disease (8)? When do they show up?

Answer 5

Spider naevi
Palmar erythema, Gynaecomastia
Loss of axillary and pubic hair
Ascites,
Encephalopathy
Jaundice
Muscle wasting

Show up in Chronic liver disease (late stage)

Question 6

AAT:ALT suggestive of afld

Answer 6

2 (AAT bigger than ALT when alcoholic liver disease because they are in the AA (Alcoholic annomylous)

Question 7

Other liver tests

Answer 7

Raised Gamma Glutamyl Transferase
Macrocytosis
Thrombocytopenia (low platelets)
USS fatty liver

Question 8

Grading of hepatic encephalopathy

Answer 8

1-4
1=mild confusion
4=coma

Question 9

(3) things to exclude with hepatic encephaopathy

Answer 9

infection
hypoglycaemia
intracranial bleed (more likely to have fallen over)

Question 10

Causes oif hepatic encephaopathy (5)

Answer 10

Infection
Constipation (bowel blockage)
GI Bleed
Electrolyte disturbanc
Drugs

Question 11

Treatment hepatic encephaopathy

Answer 11

Empty bowels
Antibiotics
Supportive

Question 12

What is Spontaneous Bacterial Peritonitis caused by? SIgns? When to be aware?

Answer 12

INfection getting out into the peritoneum, often in Ascities.
Signs: abdo pain, fever, rigors, renal impairment, sepsis, tachycardia

May vary, so need to be aware of anything that could be suggestive if advanced l;iver failure and ascites

Question 13

How to test for Spontaneous Bacterial Peritonitis and what 3 key things to look for?

Answer 13

Ascitic Tap:
Fluid Protein and Glucose levels
Cultures
White Cell Content

Question 14

Spontaneous Bacterial Peritonitis indicative levels.

Answer 14

Neutrophil Count >0.25x10*9/L
Protein <25g/L

Question 15

Treatment for Spontaneous Bacterial Peritonitis

Answer 15

IV Antibiotics

When stable: Ascites fluid drainage

IV Albumin infusion (decrease ascites)

Question 16

Alcoholic hepatitis:Presentation

Answer 16

Oftn late stage:
Jaundice, Encephalopathy, Infection
Poor hepatic function
(Low albumin and raised prothrombin time/INR)

Question 17

Diagnostic tests fpr Alcoholic hepatitis

Answer 17

Raised Bilirubin
Raised GGT and AlkP
Alcohol History
Exclude other causes

Question 18

Alcoholic hepatitis Prognosis

Answer 18

Very poor esp if severe

Question 19

Alcoholic hepatitis treatment

Answer 19

Supportive
Treat infection
Treat encephalopathy
Treat alcohol withdrawal
Protect against GI bleeding

Question 20

What is benzodiazeoines used for?

Answer 20

To help with alcohol withdrawl

Question 21

Severe score of glasgow alcoholic hepatitis score

Answer 21

9 and above

Question 22

When are steroids given in alcoholic hepatitis

Answer 22

only if very severe (Glasgow alcoholic hepatitis score above 9)

Question 23

alcoholic hepatitis nourishment levles? Worst levles of what vitamin?

Answer 23

Very bad, everyone is malnourished. one of the proven methods of treatment is to get them nourished!!

Thiamin (Vit B) is a key one that is often down

Question 24

Prognosis dependadnt on what?

Answer 24

Ability to quit alcohol

Question 25

How is (non alcoholic) Steatohepatitis often found? ALT vs AAT. How does fat appear on USS?

Answer 25

Just as part of routine blood tests. ALT>AAT.

Fat apprears as white on Ultrasound scans