Alcohol Related Disease Flashcards
What is steatosis?
Fatty liver disease
What is steatohepatitis?
Fatty liver with inflammation
Neutrophil infiltration
Fibrosis –> cirrhosis
What does CAGE stand for?
Desire: Cut down
Annoyed by criticism
Guilty about drinking
Need an Eyeopener
What is the FAST/AUDIT scale?
Risk of dependence scale
Physical findings in alcohol abuse
None
Chronic liver disease
Jaundice
Muscle wasting
Symptoms of chronic liver disease
Spider naevi Palmar erythema Gynaecomastia Loss of axillary/pubic hair Ascites Encephalopathy
Lab tests for chronic alcohol abuse
AST > ALT (>2) Raised Gamma Glutamyl Transferase Macrocytosis Thrombocytopenia BIOPSY
Radiological tests for alcohol abuse?
USS (fatty liver)
What is the grading for hepatic encephalopathy?
1 - mild confusion
4 - comatose
How does liver failure cause encephalopathy?
Build up of ammonia
Causes of Hepatic encephalopathy?
Infection Drugs Constipation GI bleed Electrolyte disturbance
What needs to be excluded when hepatic encephalopathy is suspected?
Infection
Hypoglycaemia
Intracranial bleed
What is the treatment for hepatic encephalopathy?
Bowel clear out, lactulose, enemas
Antibiotics
Supportive (NG, ITU)
What are the symptoms of spontaneous bacterial peritonitis?
Abdominal Pain Fever, rigors Ascites Renal impairment Sepsis symptoms
What is tests are performed for suspected spontaneous bacterial peritonitis?
Ascitic tap:
- Protein and gluc
- Cultures
- White cell count
Diagnostic positive results for Spontaneous bacterial peritonitis
Elevated neutrophils
Low protein
Excluded surgical causes
Treatment for spontaneous bacterial peritonitis
IV antibiotics
Ascitic drainage
IV albumin infusion
Presentation of alcoholic hepatitis
Jaundice
Encephalopathy
Infection
Low albumin with raised INR
How is alcoholic hepatitis diagnosed?
Raised bilirubin
Raised GGT, AlkP
Alcohol history
Exclusion of other causes
Prognosis of alcoholic hepatitis
40-90% mortality
Treatment for alcoholic hepatitis
Treat infection, encephalopathy, withdrawal
Protect vs GI bleed
Airway protection/ITU
When are steroids indicated in alcoholic hepatitis?
Glasgow Alcoholic grading score > 9
Maddreys discriminant > 32
Nutritional treatment for alcoholic hepatitis
100% are malnourished
THIAMINE
Freequent feeds high energy
Prolonged low thiamine can cause what?
Wernicke’s Encephalopathy
Causes of Fatty liver disease
Obesity Diabetes Hypercholesterolaemia Alcohol Benign
What is steatohepatitis?
Fatty liver disease with inflammation
What rate does steatohepatitis lead to cirrhosis?
25%
What are the symptoms of steatohepatitis?
None
How is Steatohepatitis diagnosed?
Raised AST
Fatty liver USS
Liver Biopsy
How is Steatohepatitis treated?
Weight Loss
Exercise
