Alcohol Related Disease Flashcards
What effects can alcohol have on the liver and the human body?
Encephalopathy
Sponatenous Bacterial Peritonitis
Alcoholic Hepatitis
What is a fatty liver and what can it be seen on?
Excessive fat accumulation in the liver
Ultrasound
Why can alcohol cause trouble in the liver in different ways?
Alcohol affect several different pathways
What are the signs of Chronic Liver Disease (CLD)? (8)
Spider naevi Gynaecomastia Loss of axillary hair Palmar erythema Ascites Encephalopathy Jaundice Muscle wasting
What lab results will indicate CLD?
AAT > ALT (Ratio>2)
Raised GGT
Macrocytosis
Thrombocytopenia - Low platelets
What is hepatic encephalopathy?
A state of confusion coming from liver failure
Is hepatic encephalopathy a specific sign to liver failure?
Yes, but it isn’t unique to alcohol
What are the causes of hepatic encephalopathy?
Drugs Infection Constipation GI Bleed Electrolyte imbalance
What should you exclude when considering hepatic encephalopathy?
Infection
Hypoglycaemia
Intra-Cranial bleed
What are the treatment options for hepatic encephalopathy?
Bowel wash out - First line of treatment when patient is admitted
Antibiotics
Supportive - ITU
How does a patient with spontaneous bacterial peritonitis usually present?
Skinny with a distended abdomen due to ascites
What are the symptoms of spontaneous bacterial peritonitis?
Abdominal pain
Fever
Rigors
Renal impairment
What are the signs of spontaneous bacterial peritonitis?
Sepsis
Tachycardia
Temperature changes
What are the investigations done for spontaneous bacterial peritonitis?
Fluid protein (Protein 0.25x10^9/L
What is the treatment for spontaneous bacterial peritonitis?
IV Antibiotics
Ascitic fluid drainage
IV Albumin infusion (20% ALBA)
What is alcoholic hepatitis?
Inflammation of the liver typically caused by excessive alcohol consumption over a long period of time
How does alcoholic hepatitis present?
Jaundice
Encephalopathy
Infection common
Decompensated hepatic function - Low albumin and raised prothrombin time/INR
What lab results will diagnose alcoholic hepatitis?
Raised bilirubin
Raised GGT & Alk phos
Alcohol hx
Exclude other causes
What is the mortality rate for alcoholic hepatitis?
40%
90% if the case is severe
How should alcoholic hepatitis be treated?
Supportive Treat infection Treat alcohol withdrawal Protect against GI bleeding Airway protection - ITU
What grading scale scores alcoholic hepatitis and above what number should steroids be given?
Glasgow Alcohol Hepatitis Score
Score >9
What percentage of patients are malnourished with alcoholic hepatitis and how many are severely affected?
100%
Severe- 33%
What is the prognosis of alcoholic hepatitis?
Dependent on abstinence or ongoing alcohol consumption
Steatohepatitis leads to cirrhosis
Mortality is 70% in 5 years for those with decompensating liver disease
Encephalopathy presentation = 64% of patients have a 1 year mortality
What is steatohepatitis and is it symptomatic or asymptomatic?
Fatty liver with inflammation
ASymptomatic
aka Fatty Liver Disease
What is steatosis?
The infiltration of liver hepatocytes with fat
Looks like alcohol related but it isn’t
What is a causes of fatty liver?
NAFLD
What are possible causes of steatosis?
Pregnancy Malnutrition Obesity Hepatitis C Some drugs
What is it if there is steatosis but alcohol is related and what is the prognosis?
Not NAFLD
Worse prognosis
What does steatohepatitis show on blood tests?
Increased AAT (Alanine amino transferase)
What does steatohepatitis require?
A biopsy
What percentage of steatohepatitis patients develop cirrhosis?
25%
What is the treatment for steatohepatitis?
Weight loss
Exercise
This is on the rise
What does neutrophil infiltration lead to?
Inflammation & Cirrhosis
What method should be used when taking a history on how alcohol dependent someone is?
FAST/AUDIT
