Alcohol Related Disease

Question 1

What is steatosis?

Answer 1

Fatty liver disease

Question 2

What is steatohepatitis?

Answer 2

Fatty liver with inflammation
Neutrophil infiltration
Fibrosis –> cirrhosis

Question 3

What does CAGE stand for?

Answer 3

Desire: Cut down
Annoyed by criticism
Guilty about drinking
Need an Eyeopener

Question 4

What is the FAST/AUDIT scale?

Answer 4

Risk of dependence scale

Question 5

Physical findings in alcohol abuse

Answer 5

None
Chronic liver disease
Jaundice
Muscle wasting

Question 6

Symptoms of chronic liver disease

Answer 6

Spider naevi 
Palmar erythema 
Gynaecomastia
Loss of axillary/pubic hair
Ascites
Encephalopathy

Question 7

Lab tests for chronic alcohol abuse

Answer 7

AST > ALT (>2)
Raised Gamma Glutamyl Transferase
Macrocytosis 
Thrombocytopenia
BIOPSY

Question 8

Radiological tests for alcohol abuse?

Answer 8

USS (fatty liver)

Question 9

What is the grading for hepatic encephalopathy?

Answer 9

1 - mild confusion

4 - comatose

Question 10

How does liver failure cause encephalopathy?

Answer 10

Build up of ammonia

Question 11

Causes of Hepatic encephalopathy?

Answer 11

Infection
Drugs
Constipation
GI bleed
Electrolyte disturbance

Question 12

What needs to be excluded when hepatic encephalopathy is suspected?

Answer 12

Infection
Hypoglycaemia
Intracranial bleed

Question 13

What is the treatment for hepatic encephalopathy?

Answer 13

Bowel clear out, lactulose, enemas
Antibiotics
Supportive (NG, ITU)

Question 14

What are the symptoms of spontaneous bacterial peritonitis?

Answer 14

Abdominal Pain
Fever, rigors
Ascites
Renal impairment
Sepsis symptoms

Question 15

What is tests are performed for suspected spontaneous bacterial peritonitis?

Answer 15

Ascitic tap:

• Protein and gluc
• Cultures
• White cell count

Question 16

Diagnostic positive results for Spontaneous bacterial peritonitis

Answer 16

Elevated neutrophils
Low protein

Excluded surgical causes

Question 17

Treatment for spontaneous bacterial peritonitis

Answer 17

IV antibiotics
Ascitic drainage
IV albumin infusion

Question 18

Presentation of alcoholic hepatitis

Answer 18

Jaundice
Encephalopathy
Infection
Low albumin with raised INR

Question 19

How is alcoholic hepatitis diagnosed?

Answer 19

Raised bilirubin
Raised GGT, AlkP
Alcohol history
Exclusion of other causes

Question 20

Prognosis of alcoholic hepatitis

Answer 20

40-90% mortality

Question 21

Treatment for alcoholic hepatitis

Answer 21

Treat infection, encephalopathy, withdrawal
Protect vs GI bleed
Airway protection/ITU

Question 22

When are steroids indicated in alcoholic hepatitis?

Answer 22

Glasgow Alcoholic grading score > 9

Maddreys discriminant > 32

Question 23

Nutritional treatment for alcoholic hepatitis

Answer 23

100% are malnourished
THIAMINE
Freequent feeds high energy

Question 24

Prolonged low thiamine can cause what?

Answer 24

Wernicke’s Encephalopathy

Question 25

Causes of Fatty liver disease

Answer 25

Obesity
Diabetes
Hypercholesterolaemia
Alcohol 
Benign

Question 26

What is steatohepatitis?

Answer 26

Fatty liver disease with inflammation

Question 27

What rate does steatohepatitis lead to cirrhosis?

Answer 27

25%

Question 28

What are the symptoms of steatohepatitis?

Answer 28

None

Question 29

How is Steatohepatitis diagnosed?

Answer 29

Raised AST
Fatty liver USS
Liver Biopsy

Question 30

How is Steatohepatitis treated?

Answer 30

Weight Loss

Exercise