Alcohol Related Disease Flashcards by Sophia Boyce

What is the effect of alcohol on the liver?

Direct toxicity

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Which gender metabolises alcohol slower?

Women

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Why does alcohol affect people differently?

Depends on genetics and how we metabolise alcohol

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What is the toxic product of alcohol breakdown, and what is it broken down to in the liver by acetaldehyde/alcohol dehydrogenase?

Acetaldehyde broken down to acetate

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When the liver is metabolising alcohol what is interrupted?

Other metabolic pathways i.e. breakdown of fats or glycogen

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What is steatosis?

Fatty liver

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What is steatohepatitis?

Fatty liver with inflammation

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What happens in steatohepatitis?

Neutrophil infiltration

Leads to fibrosis, cirrhosis (buildup of scar tissue)

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What is one unit of alcohol in: beer (+ lager + cider), wine. spirits, sherry, aperitifs

Beer = half pint 
Wine = small glass
Spirits = single measure
Sherry = small glass
Aperitif = single measure

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What is the recommended limit for alcohol unit consumption weekly?

14 units preferably over 3 days

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What chart is used to determine level of alcohol dependence?

FAST/AUDIT

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What are the physical findings in alcohol related pathologies like steatosis and steatohepatitis?

Majority none until advanced liver disease

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Give 6 signs of chronic liver disease

spider naevi
palmar erythema
gynaecomastia
loss of axillary and pubic hair
ascites
encephalopathy

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What can also indicate alcoholic liver damage?

Jaundice - late stage

Muscle wasting - weight loss - cachexia

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Name 2 LFT results found in liver disease (AAT,ALT; GGT) (not specific to alcohol but found in it)

Aspartate amino transferase (AAT) > alanine amino transferase (ALT); ratio > 2
Raised Gamma Glutamyl Transferase

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Name 2 other lab results found

Macrocytosis

Thrombocytopenia (low platelets)

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Name another investigation that can be done in liver disease

USS fatty liver

can also do liver biopsy

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What is hepatic encephalopathy?

A syndrome observed in patients with cirrhosis; defined as a spectrum of neuropsychiatric abnormalities in patients with liver dysfunction; liver cant process toxins so there is a buildup of ammonia = confusion

How is hepatic encephalopathy graded? What do the 2 extremes indicate?

Graded 1-4
1 = mild confusion
4 = coma

Name possible causes of hepatic encephalopathy

Infection 
Drugs
Constipation
GI bleed
Electrolyte disturbance

What is important to exclude in hepatic encephalopathy?

Infection
Hypoglycaemia
Intra-Cranial bleed

Treatment for hepatic encephalopathy? (3 types)

Bowel clear out (lactulose, enemas)
Abx
Supportive (ITU, airway support, NG tube for meds)

What is spontaneous bacterial peritonitis?

Infection of ascitic fluid without an apparent source; can be a feature of advanced/end-stage liver disease

Give some signs of spontaneous bacterial peritonitis?

Abdominal pain
Fever, rigors
Renal impairment
Sepsis, tachycardia, temperature

What diagnostic investigation can be done for SBP? What should be tested for?

Ascitic tap ! - Fluid protein and glucose levels - Cultures - White cell content

What would the expected neutrophil count and protein level be in SBP?

Neutrophil count >0.25x10^9/L - diagnostic! Protein <25g/L (exclude surgical causes)

Treatment for SBP? (3 types)

IV abx Ascitic fluid drainage IV albumin infusion (20% ALBA) (improves perfusion of kidneys - reduced risk of renal failure)

Give some presenting features of alcoholic hepatitis

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

3 components for diagnosis of alcoholic hepatitis? (2 are tests)

- Raised bilirubin - Raised GGT and AlkP - Alcohol history (exclude other causes)

Prognosis for alcoholic hepatitis?

40% mortality | if severe - up to 90%

Treatment for alcoholic hepatitis? (lots)

- Supportive - Treat infection - Treat encephalopathy - Treat alcohol withdrawal (can cause hallucinations, seizures etc!) - Protect against GI bleeding (can have oesophageal ulcers!) - Airway protection/ITU care

What treatment can be given in alcoholic hepatitis score if the Glasgow Alcoholic Hepatitis score is >9?

Steroids

Why is nutrition part of the treatment for alcoholic hepatitis?

100% of patients are malnourishes (33% severely) 2 yr survival 15% vs 70% if well nourished !!Thiamine deficiency - can cause brain damage

What is the nutritional support for AH?

Frequent feeds | High energy requirement

What is prognosis of AH dependant on?

Abstinence or ongoing alcohol consumption If liver can be treated in hosp - after if stop drinking liver will repair and function normally (90% survival vs 50% if continue drinking)

2 types of 'fatty liver'?

``` Steatosis = fatty liver, non alcoholic fatty liver (NAFLD) Steatohepatitis = non alcoholic steatohepatitis (NASH) ```

What is fatty liver linked with?

Obesity Diabetes Hypercholesterolaemia (alcohol)

What 2 things cause steatohepatitis (pathologically)

Fat + inflammation

What is fatty liver histologically similar to?

Alcohol induced damage

Steatohepatitis can be asymptomatic; what 3 tests diagnose it?

Raised AAT Fatty liver on USS Liver biopsy

Treatment for steatohepatitis?

Weight loss | Exercise

What can alcohol induced steatosis lead to?

Alcoholic hepatitis

When is alcoholic hepatitis treated with oral corticosteroids?

When maddrey's discriminant >32