Alcohol Related Disease Flashcards
What is the difference between steatosis and steatohepatitis?
Steatosis is fatty liver
Steatohepatitis is fatty liver with inflammation
What questions that need to be asked in history are covered in the CAGE mnemonic?
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 score on a FAST questionnaire is considered to be FAST positive?
A total score of 3 or more
When should an AUDIT score be obtained?
When the patient is deemed FAST positive
What scores on an AUDIT test correspond to increasing risk, higher risk and possible dependence?
Increasing risk- 8-15
Higher risk- 16-19
Possible dependence- 20+
What are some common signs of chronic liver disease?
Spider naevi Palmar erythema Gynaecomastia Loss of axillary and pubic hair Ascites Encephalopathy
What lab tests are indicative of alcohol related liver disease?
Aspartate amino transferase (AAT) > alanine amino transferase (ALT) ratio >2
Raised gamma glutamyl transferase
Macrocytosis
Thrombocytopenia (low platelets)
How is hepatic encephalopathy graded?
Graded 1-4
1 corresponds to mild confusion
4 corresponds to coma
What are the causes of hepatic encephalopathy?
Infection Drugs Constipation GI bleed Electrolyte disturbance
What interventions should be made in cases of hepatic encephalopathy?
Bowel clear out- lactulose or enema
Antibiotics
Supportive- ITU airway support, NG tubes for meds
What are the symptoms of bacterial peritonitis?
Abdominal pain Fever Rigors Renal impairment Tachycardia Temperature
What test should be done in suspected cases of spontaneous bacterial peritonitis?
An ascitic tap looking for:
Fluid protein and glucose levels
White cell content
And to grow cultures
What neutrophil count and protein levels are indicative of spontaneous bacterial peritonitis?
Neutrophil count >0.25x10^9/L
Protein <25g/L
What interventions should be made in cases of spontaneous bacterial peritonitis?
IV antibiotics
Ascitic fluid drainage
IV albumin infusion (20% ALBA)
How would alcoholic hepatitis usually present?
Jaundice
Encephalopathy
Infections common
Decompensated hepatic function (low albumin and raised prothrombin time)
How is alcoholic hepatitis diagnosed?
Raised bilirubin
Raised GGT and AlkP
Alcohol history
Exclude other causes
What is the mortality rate of alcoholic hepatitis?
40%
In severe cases up to 90%
What interventions should be made in cases of alcoholic hepatitis?
Treat infection Treat encephalopathy Treat alcohol withdrawal Protect against GI bleeding Airway protection/ITU care
When should steroids be given for alcoholic hepatitis?
When a Glasgow alcoholic hepatitis score >9 is present
What are the causes of fatty liver?
Obesity
Diabetes
Hypercholesterolaemia
Alcohol
What fraction of those with steatohepatitis develop cirrhosis?
1/4
What is the treatment for steatohepatitis?
Weight loss and exercise
