Alcohol Related Disease Flashcards
Does everyone metabolise alcohol the same?
No, there are genetic differences in how individual’s metabolise alcohol
What does alcohol dehydrogenase do?
Breaks alcohol down into a toxic metabolite acetaldehyde.
What can acetaldehyde cause to happen?
Unpleasant side effects like flushing and nausea, which can limit how much people drink
What happens if the pathway of breaking ethanol into acetaldehyde becomes saturated?
Alcohol has to get broken down using other pathways
What happens if the alternative breakdown pathways become saturated?
Toxic metabolites build up
Which other metabolites may start to build up?
Excess lipids as the alcohol goes down the fatty acid pathway.
What does the build up of lipids lead to?
Build up of lactic acid and ketones which leads to acidosis and a breakdown in the gluconeogenesis glycolysis pathway,
What may happen after acidosis?
Hyperglycaemia as you can no longer metabolise stores of glucose
What is meant by steatosis?
Fatty liver
What is meant by steatohepatitis?
Inflammation of the liver with background fat
What can steatohepatitis lead to or cause?
Scarring or fibrosis of the liver and ultimately cirrhosis
Which questionnaire can be taken in order to determine someone’s alcohol intake?
CAGE
What are the questions asked in CAGE?
Just for a general idea :)
- Have you ever felt the need to cut down?
- Have you ever been annoyed by criticism of you drinking?
- Have you felt guilty about drinking?
- Do you need an eye opener?
What is the alcohol screening tool called?
FAST
Give some proportions of drinks which add up to a unit of alcohol.
125ml glass of wine
25ml spirit
Half a pint
How much do you need to score in FAST scoring to be deemed a heavier drinker?
> 3
When someone prevents with alcohol related liver disease, what is normally seen?
Normally nothing, it may not be found until advanced liver disease
Which symptoms may you get with advanced liver disease, not just because of alcohol?
Spider naevi
Parenchymal
Gynecomastia
Ascites
Jaundice
Muscle wasting
While blood tests are non-specific, which finding would be suggestive of alcohol?
If AAT is more than double ALT
AAT= Alpha-1 Antitrypsin
ALT Alanine Transaminase
When may hepatic encephalopathy occur?
At any point in end-stage liver disease but can be suggestive of liver failure
What are some causes of hepatic encephalopathy?
Infections
Drugs
Constipation
GI bleed
RECAP- what is hepatic encephalopathy?
Confusion
Why may constipation be a cause of hepatic encephalopathy?
If bowels are not clearing, there can be a build-up of toxic metabolites such as ammonia which can cause hepatic encephalopathy
What must you exclude before diagnosis of hepatic encephalopathy?
Infection
Hypoglycaemia
Brain bleed
How can bowels be cleared if someone has constipation?
Laxatives
Enemas
What is spontaneous bacterial peritonitis?
Infection of ascites (excess fluid in abdomen)
What will patients with spontaneous bacterial peritonitis present with?
Abdominal pain
Rigours (swinging fever)
Renal impairment
How is spontaneous bacterial peritonitis diagnosed?
Ascitic tap to test fluid
What do you test the ascites fluid for?
Protein and glucose levels
Cultures to find out which bacteria has caused the infection
WBC content
What WBC count would suggest spontaneous bacterial peritonitis?
> 0.25
Do protein levels tend to be high or low in those with spontaneous bacterial peritonitis?
Low
What is the treatment for spontaneous bacterial peritonitis?
High dose broad spectrum antibiotic
How may the high dose broad spectrum antibiotic be given to those with spontaneous bacterial peritonitis?
Intra-venously
What can be given to those with spontaneous bacterial peritonitis to increase vascular volume?
Albumin as this reduces chances of reoccurrence of ascitic fluid
What will patients with alcoholic hepatitis present with?
Jaundice
Encephalopathy
Infection is common
What would blood tests of someone with alcoholic hepatitis show?
Raised bilirubin
Raised GGT (Gamma Gt)
Raised ALKPHOS
When taking a history, what part is important to confirm the diagnosis of alcoholic hepatitis?
Must have a history of drinking, cannot diagnose alcoholic hepatitis if patient does not drink
What are some differential diagnoses for someone with jaundice?
Bile duct obstruction
Gall stones
Pancreatic cancer
Viral hepatitis
Drug induced liver disease
What are some of the treatment options for alcoholic hepatitis?
Mostly supportive-
Treat infection
Treat encephalopathy
Treat alcohol withdrawal
Which drug can be given to minimise alcohol withdrawal?
Benzodiazepines
What are those with alcoholic hepatitis at a higher risk of?
GI bleed
What is the usual alcoholic hepatitis scoring system usually used?
Glasgow Alcoholic Hepatitis Score
->classical use of Glasgow
What happens if you have a Glasgow Alcoholic Hepatitis score >9?
Graded as having severe alcoholic hepatitis
What is the treatment for those with severe alcoholic hepatitis?
Steroids- prednisolone
What are the risks of taking prednisolone?
Increased risks of GI bleeding and infection
Which other test can be used to grade alcoholic hepatitis as well as Glasgow Alcoholic Hepatitis Score?
Maddrey’s discriminant function.
Which score of the Maddrey’s discriminant function would indicate severe alcoholic hepatitis?
> 32
How are those with alcoholic hepatitis affected nutrioanlly?
100% are malnourished!!!
Which vitamin is most deficient in individuals with alcoholic hepatitis?
Vitamin B (thiamine)
What happens if the thiamine (vit.B) is not replenished?
Permanent brain damage
