Alcohol related disease Flashcards
metabolism of alcohol
Ethanol -> Acetaldehyde (toxic) -> Acetate
When conjested can lead to:
-excess fat
-hypoglycemia
-ketosis
-acidosis
What is steatosis vs steatohepititis?
STeatosis = fat in liver cells
Steatohepititis = fat in liver cells -> INFLAMMATION
CAGE questions
C- ut down (thought about)
A - Annoyed (at critisism of drinking)
G - Guilty (about drinking)
E - Eyeopener (needed it in the morning)
What is the fast scoring sysytem?
An easy way to score how much alcohol a patient has drank based on easy calculations of units etc
What are the signs of chronic liver disease (8)? When do they show up?
Spider naevi
Palmar erythema, Gynaecomastia
Loss of axillary and pubic hair
Ascites,
Encephalopathy
Jaundice
Muscle wasting
Show up in Chronic liver disease (late stage)
AAT:ALT suggestive of afld
2 (AAT bigger than ALT when alcoholic liver disease because they are in the AA (Alcoholic annomylous)
Other liver tests
Raised Gamma Glutamyl Transferase
Macrocytosis
Thrombocytopenia (low platelets)
USS fatty liver
Grading of hepatic encephalopathy
1-4
1=mild confusion
4=coma
(3) things to exclude with hepatic encephaopathy
infection
hypoglycaemia
intracranial bleed (more likely to have fallen over)
Causes oif hepatic encephaopathy (5)
Infection
Constipation (bowel blockage)
GI Bleed
Electrolyte disturbanc
Drugs
Treatment hepatic encephaopathy
Empty bowels
Antibiotics
Supportive
What is Spontaneous Bacterial Peritonitis caused by? SIgns? When to be aware?
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
How to test for Spontaneous Bacterial Peritonitis and what 3 key things to look for?
Ascitic Tap:
Fluid Protein and Glucose levels
Cultures
White Cell Content
Spontaneous Bacterial Peritonitis indicative levels.
Neutrophil Count >0.25x10*9/L
Protein <25g/L
Treatment for Spontaneous Bacterial Peritonitis
IV Antibiotics
When stable: Ascites fluid drainage
IV Albumin infusion (decrease ascites)
Alcoholic hepatitis:Presentation
Oftn late stage:
Jaundice, Encephalopathy, Infection
Poor hepatic function
(Low albumin and raised prothrombin time/INR)
Diagnostic tests fpr Alcoholic hepatitis
Raised Bilirubin
Raised GGT and AlkP
Alcohol History
Exclude other causes
Alcoholic hepatitis Prognosis
Very poor esp if severe
Alcoholic hepatitis treatment
Supportive
Treat infection
Treat encephalopathy
Treat alcohol withdrawal
Protect against GI bleeding
What is benzodiazeoines used for?
To help with alcohol withdrawl
Severe score of glasgow alcoholic hepatitis score
9 and above
When are steroids given in alcoholic hepatitis
only if very severe (Glasgow alcoholic hepatitis score above 9)
alcoholic hepatitis nourishment levles? Worst levles of what vitamin?
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
Prognosis dependadnt on what?
Ability to quit alcohol
How is (non alcoholic) Steatohepatitis often found? ALT vs AAT. How does fat appear on USS?
Just as part of routine blood tests. ALT>AAT.
Fat apprears as white on Ultrasound scans
