Alcohol Related Disease Flashcards
How does alcohol metabolisation differ between the sexes?
Women metabolise slower than men
Describe the pathways of ethanol metabolism?
- Alcohol dehydrogenase changes ethanol to acetaldehyde
- Acetaldehyde dehydrogenase changes acetaldehyde to acetate
How do patients present as a result of metabolism processes?
- Excess lipids
- Hypoglycaemic
- Acidotic
- Build up of ketones
What are 2 common presentations of alcohol and the liver?
- Staetosis
- Staetohepatitis
Steatosis
Fatty liver, non-alcoholic fatty liver (NAFLD)
Steatohepatitis
Fatty liver with inflammation, non-alcoholic steatohepatitis (NASH)
Why is there inflammation present with steatohepatitis?
- Neutrophil infiltration
- Fibrosis
- Cirrhosis
- Build up of scar tissue
What questions are included in the CAGE questionnaire?
- 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?
What is 1 unit of alcohol equivalent to?
- 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
When should patients complete an AUDIT questionnaire as well as a FAST questionnaire?
When they have an overall FAST score of 3 or more
What may the physical findings of a liver affected by alcohol be?
- Majority there is no physical findings until advanced disease
- Signs of chronic liver disease
- Jaundice
- Muscle wasting
What are signs of chronic liver disease?
- Spider naevi
- Palmar erythema
- Gynaecomastia
- Loss of axillary and pubic hair
- Ascites
- Encephalopathy
What laboratory investigations findings might there be?
-Aspartate amino transferase (AAT)> alanine amino transferase (ALT). Ratio >2
-Raised gamma glutamyl transferase
Macrocytosis
-Thrombocytopenia (low platelets
What findings might be found on investigation?
-USS of fatty liver
What is hepatic encephalopathy due to?
Liver failure leading to a build up of ammonia
How is hepatic encephalopathy graded?
- Graded 1-4
- 1: mild confusion
- 4: coma
What can cause hepatic encephalopathy?
- Infection
- Drugs
- Constipation
- GI bleed
- Electrolyte disturbance
What should be excluded first before diagnosing hepatic encephalopathy?
- Infection
- Hypoglycaemia
- Intra cranial bleed
What is the treatment for hepatic encephalopathy?
- Bowel clear out, lactulose, enema
- Antibiotics
- Supportive
What does supportive treatment include for hepatic encephalopathy?
- ITU
- Airway support
- NG tube for meds
How does spontaneous bacterial peritonitis present?
- Abdominal pain
- Fever
- Rigors
- Renal impairment
- Signs of sepsis, tachycardia, temperature
What should the fluid from an ascites tap be tested for?
- Fluid protein and glucose levels
- Cultures
- White cell content
Before diagnosing spontaneous bacterial peritonitis what should be excluded?
Surgical causes of peritonitis
What is the neutrophil count in spontaneous bacterial peritonitis?
> 0.25x10^9/L
What is the protein level in spontaneous bacterial peritonitis?
<25g/L
What is the treatment for spontaneous bacterial peritonitis?
- IV antibiotics
- Ascitic fluid drainage
- IV albumin infusion (20% ALBA)
How does alcoholic hepatitis present?
- Jaundice
- Encephalopathy
- Infection common
- Decompensated hepatic function (low albumin and raised prothrombin time/INR)
How is alcoholic hepatitis diagnosed?
- Raised bilirubin
- Raised GGT and AlkP
- Alcohol history
- Exclude other causes
What is the prognosis of alcoholic hepatitis?
- 40% mortality
- Up to 90% mortality in severe cases
What is the treatment for alcoholic hepatitis?
- Supportive
- Treat infection
- Treat encephalopathy
- Treat alcohol withdrawal
- Protect against GI bleeding
- Airway protection/ ITU care
- Steroids
- Nutrition
When should steroids be used to treat alcoholic hepatitis?
- If graded severe
- Glasgow Alcoholic Hepatitis score >9
- Maddreys discriminant function>32
Why is it important to give nutritional support to those with alcoholic hepatitis?
- 100% are malnourished and therefore have very poor prognosis-Require frequent feeds, high energy requirement
- Thiamine is very important
What is prognosis from alcoholic hepatitis dependent on?
Whether the patient abstains from alcohol or if there is ongoing consumption
What does steatohepatitis lead to?
Cirrhosis
The mortality rate of hepatic hepatitis increases when what else is present?
- Decompensating liver disease
- Encephalopathy
What can cause fatty liver?
- Obesity
- Diabetes
- Hypercholesterolaemia
- Alcohol
- Benign
What is the histology of steatohepatitis similar to?
Histology of alcohol induced damage
What do 1/4 of patients with steatohepatitis go on to develop?
Cirrhosis
How can steatohepatisis be diagnosed?
- Asymptomatic
- Raised alanine amino transferase
- Fatty liver on USS
- Liver biopsy
What is the treatment for steatohepatitis?
- Weight loss
- Exercise
