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Year 2- GIT > Alcohol Related Disease > Flashcards

Alcohol Related Disease Flashcards

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1
Q

Does everyone metabolise alcohol the same?

A

No, there are genetic differences in how individual’s metabolise alcohol

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2
Q

What does alcohol dehydrogenase do?

A

Breaks alcohol down into a toxic metabolite acetaldehyde.

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3
Q

What can acetaldehyde cause to happen?

A

Unpleasant side effects like flushing and nausea, which can limit how much people drink

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4
Q

What happens if the pathway of breaking ethanol into acetaldehyde becomes saturated?

A

Alcohol has to get broken down using other pathways

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5
Q

What happens if the alternative breakdown pathways become saturated?

A

Toxic metabolites build up

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6
Q

Which other metabolites may start to build up?

A

Excess lipids as the alcohol goes down the fatty acid pathway.

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7
Q

What does the build up of lipids lead to?

A

Build up of lactic acid and ketones which leads to acidosis and a breakdown in the gluconeogenesis glycolysis pathway,

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8
Q

What may happen after acidosis?

A

Hyperglycaemia as you can no longer metabolise stores of glucose

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9
Q

What is meant by steatosis?

A

Fatty liver

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10
Q

What is meant by steatohepatitis?

A

Inflammation of the liver with background fat

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11
Q

What can steatohepatitis lead to or cause?

A

Scarring or fibrosis of the liver and ultimately cirrhosis

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12
Q

Which questionnaire can be taken in order to determine someone’s alcohol intake?

A

CAGE

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13
Q

What are the questions asked in CAGE?

A

Just for a general idea :)

  1. Have you ever felt the need to cut down?
  2. Have you ever been annoyed by criticism of you drinking?
  3. Have you felt guilty about drinking?
  4. Do you need an eye opener?
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14
Q

What is the alcohol screening tool called?

A

FAST

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15
Q

Give some proportions of drinks which add up to a unit of alcohol.

A

125ml glass of wine
25ml spirit
Half a pint

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16
Q

How much do you need to score in FAST scoring to be deemed a heavier drinker?

A

> 3

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17
Q

When someone prevents with alcohol related liver disease, what is normally seen?

A

Normally nothing, it may not be found until advanced liver disease

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18
Q

Which symptoms may you get with advanced liver disease, not just because of alcohol?

A

Spider naevi
Parenchymal
Gynecomastia
Ascites
Jaundice
Muscle wasting

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19
Q

While blood tests are non-specific, which finding would be suggestive of alcohol?

A

If AAT is more than double ALT

AAT= Alpha-1 Antitrypsin
ALT Alanine Transaminase

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20
Q

When may hepatic encephalopathy occur?

A

At any point in end-stage liver disease but can be suggestive of liver failure

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21
Q

What are some causes of hepatic encephalopathy?

A

Infections
Drugs
Constipation
GI bleed

22
Q

RECAP- what is hepatic encephalopathy?

A

Confusion

23
Q

Why may constipation be a cause of hepatic encephalopathy?

A

If bowels are not clearing, there can be a build-up of toxic metabolites such as ammonia which can cause hepatic encephalopathy

24
Q

What must you exclude before diagnosis of hepatic encephalopathy?

A

Infection
Hypoglycaemia
Brain bleed

25
Q

How can bowels be cleared if someone has constipation?

A

Laxatives
Enemas

26
Q

What is spontaneous bacterial peritonitis?

A

Infection of ascites (excess fluid in abdomen)

27
Q

What will patients with spontaneous bacterial peritonitis present with?

A

Abdominal pain
Rigours (swinging fever)
Renal impairment

28
Q

How is spontaneous bacterial peritonitis diagnosed?

A

Ascitic tap to test fluid

29
Q

What do you test the ascites fluid for?

A

Protein and glucose levels
Cultures to find out which bacteria has caused the infection
WBC content

30
Q

What WBC count would suggest spontaneous bacterial peritonitis?

A

> 0.25

31
Q

Do protein levels tend to be high or low in those with spontaneous bacterial peritonitis?

A

Low

32
Q

What is the treatment for spontaneous bacterial peritonitis?

A

High dose broad spectrum antibiotic

33
Q

How may the high dose broad spectrum antibiotic be given to those with spontaneous bacterial peritonitis?

A

Intra-venously

34
Q

What can be given to those with spontaneous bacterial peritonitis to increase vascular volume?

A

Albumin as this reduces chances of reoccurrence of ascitic fluid

35
Q

What will patients with alcoholic hepatitis present with?

A

Jaundice
Encephalopathy
Infection is common

36
Q

What would blood tests of someone with alcoholic hepatitis show?

A

Raised bilirubin
Raised GGT (Gamma Gt)
Raised ALKPHOS

37
Q

When taking a history, what part is important to confirm the diagnosis of alcoholic hepatitis?

A

Must have a history of drinking, cannot diagnose alcoholic hepatitis if patient does not drink

38
Q

What are some differential diagnoses for someone with jaundice?

A

Bile duct obstruction
Gall stones
Pancreatic cancer
Viral hepatitis
Drug induced liver disease

39
Q

What are some of the treatment options for alcoholic hepatitis?

A

Mostly supportive-
Treat infection
Treat encephalopathy
Treat alcohol withdrawal

40
Q

Which drug can be given to minimise alcohol withdrawal?

A

Benzodiazepines

41
Q

What are those with alcoholic hepatitis at a higher risk of?

A

GI bleed

42
Q

What is the usual alcoholic hepatitis scoring system usually used?

A

Glasgow Alcoholic Hepatitis Score

->classical use of Glasgow

43
Q

What happens if you have a Glasgow Alcoholic Hepatitis score >9?

A

Graded as having severe alcoholic hepatitis

44
Q

What is the treatment for those with severe alcoholic hepatitis?

A

Steroids- prednisolone

45
Q

What are the risks of taking prednisolone?

A

Increased risks of GI bleeding and infection

46
Q

Which other test can be used to grade alcoholic hepatitis as well as Glasgow Alcoholic Hepatitis Score?

A

Maddrey’s discriminant function.

47
Q

Which score of the Maddrey’s discriminant function would indicate severe alcoholic hepatitis?

A

> 32

48
Q

How are those with alcoholic hepatitis affected nutrioanlly?

A

100% are malnourished!!!

49
Q

Which vitamin is most deficient in individuals with alcoholic hepatitis?

A

Vitamin B (thiamine)

50
Q

What happens if the thiamine (vit.B) is not replenished?

A

Permanent brain damage

51
Q
A

Year 2- GIT (37 decks)

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