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Systems: Alimentary AB > Alcohol Related Disease > Flashcards

Alcohol Related Disease Flashcards

1
Q

How does alcohol metabolisation differ between the sexes?

A

Women metabolise slower than men

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2
Q

Describe the pathways of ethanol metabolism?

A
  • Alcohol dehydrogenase changes ethanol to acetaldehyde

- Acetaldehyde dehydrogenase changes acetaldehyde to acetate

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3
Q

How do patients present as a result of metabolism processes?

A
  • Excess lipids
  • Hypoglycaemic
  • Acidotic
  • Build up of ketones
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4
Q

What are 2 common presentations of alcohol and the liver?

A
  • Staetosis

- Staetohepatitis

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5
Q

Steatosis

A

Fatty liver, non-alcoholic fatty liver (NAFLD)

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6
Q

Steatohepatitis

A

Fatty liver with inflammation, non-alcoholic steatohepatitis (NASH)

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7
Q

Why is there inflammation present with steatohepatitis?

A
  • Neutrophil infiltration
  • Fibrosis
  • Cirrhosis
  • Build up of scar tissue
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8
Q

What questions are included in the CAGE questionnaire?

A
  • Have you ever felt the need to cut down?
  • Have you been annoyed by criticism of your drinking?
  • Have you felt guilty about your drinking?
  • Do you need an eyeopener?
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9
Q

What is 1 unit of alcohol equivalent to?

A
  • Half pint of regular beer, lager or cider
  • 1 small glass of wine
  • 1 single measure of spirits
  • 1 small glass of sherry
  • 1 single measure of aperitifs
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10
Q

When should patients complete an AUDIT questionnaire as well as a FAST questionnaire?

A

When they have an overall FAST score of 3 or more

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11
Q

What may the physical findings of a liver affected by alcohol be?

A
  • Majority there is no physical findings until advanced disease
  • Signs of chronic liver disease
  • Jaundice
  • Muscle wasting
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12
Q

What are signs of chronic liver disease?

A
  • Spider naevi
  • Palmar erythema
  • Gynaecomastia
  • Loss of axillary and pubic hair
  • Ascites
  • Encephalopathy
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13
Q

What laboratory investigations findings might there be?

A

-Aspartate amino transferase (AAT)> alanine amino transferase (ALT). Ratio >2
-Raised gamma glutamyl transferase
Macrocytosis
-Thrombocytopenia (low platelets

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14
Q

What findings might be found on investigation?

A

-USS of fatty liver

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15
Q

What is hepatic encephalopathy due to?

A

Liver failure leading to a build up of ammonia

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16
Q

How is hepatic encephalopathy graded?

A
  • Graded 1-4
  • 1: mild confusion
  • 4: coma
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17
Q

What can cause hepatic encephalopathy?

A
  • Infection
  • Drugs
  • Constipation
  • GI bleed
  • Electrolyte disturbance
18
Q

What should be excluded first before diagnosing hepatic encephalopathy?

A
  • Infection
  • Hypoglycaemia
  • Intra cranial bleed
19
Q

What is the treatment for hepatic encephalopathy?

A
  • Bowel clear out, lactulose, enema
  • Antibiotics
  • Supportive
20
Q

What does supportive treatment include for hepatic encephalopathy?

A
  • ITU
  • Airway support
  • NG tube for meds
21
Q

How does spontaneous bacterial peritonitis present?

A
  • Abdominal pain
  • Fever
  • Rigors
  • Renal impairment
  • Signs of sepsis, tachycardia, temperature
22
Q

What should the fluid from an ascites tap be tested for?

A
  • Fluid protein and glucose levels
  • Cultures
  • White cell content
23
Q

Before diagnosing spontaneous bacterial peritonitis what should be excluded?

A

Surgical causes of peritonitis

24
Q

What is the neutrophil count in spontaneous bacterial peritonitis?

A

> 0.25x10^9/L

25
Q

What is the protein level in spontaneous bacterial peritonitis?

A

<25g/L

26
Q

What is the treatment for spontaneous bacterial peritonitis?

A
  • IV antibiotics
  • Ascitic fluid drainage
  • IV albumin infusion (20% ALBA)
27
Q

How does alcoholic hepatitis present?

A
  • Jaundice
  • Encephalopathy
  • Infection common
  • Decompensated hepatic function (low albumin and raised prothrombin time/INR)
28
Q

How is alcoholic hepatitis diagnosed?

A
  • Raised bilirubin
  • Raised GGT and AlkP
  • Alcohol history
  • Exclude other causes
29
Q

What is the prognosis of alcoholic hepatitis?

A
  • 40% mortality

- Up to 90% mortality in severe cases

30
Q

What is the treatment for alcoholic hepatitis?

A
  • Supportive
  • Treat infection
  • Treat encephalopathy
  • Treat alcohol withdrawal
  • Protect against GI bleeding
  • Airway protection/ ITU care
  • Steroids
  • Nutrition
31
Q

When should steroids be used to treat alcoholic hepatitis?

A
  • If graded severe
  • Glasgow Alcoholic Hepatitis score >9
  • Maddreys discriminant function>32
32
Q

Why is it important to give nutritional support to those with alcoholic hepatitis?

A
  • 100% are malnourished and therefore have very poor prognosis-Require frequent feeds, high energy requirement
  • Thiamine is very important
33
Q

What is prognosis from alcoholic hepatitis dependent on?

A

Whether the patient abstains from alcohol or if there is ongoing consumption

34
Q

What does steatohepatitis lead to?

A

Cirrhosis

35
Q

The mortality rate of hepatic hepatitis increases when what else is present?

A
  • Decompensating liver disease

- Encephalopathy

36
Q

What can cause fatty liver?

A
  • Obesity
  • Diabetes
  • Hypercholesterolaemia
  • Alcohol
  • Benign
37
Q

What is the histology of steatohepatitis similar to?

A

Histology of alcohol induced damage

38
Q

What do 1/4 of patients with steatohepatitis go on to develop?

A

Cirrhosis

39
Q

How can steatohepatisis be diagnosed?

A
  • Asymptomatic
  • Raised alanine amino transferase
  • Fatty liver on USS
  • Liver biopsy
40
Q

What is the treatment for steatohepatitis?

A
  • Weight loss

- Exercise

Systems: Alimentary AB (37 decks)

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