Alcohol Related Disease Flashcards
What is the effect of alcohol on the liver?
Direct toxicity
Which gender metabolises alcohol slower?
Women
Why does alcohol affect people differently?
Depends on genetics and how we metabolise alcohol
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
When the liver is metabolising alcohol what is interrupted?
Other metabolic pathways i.e. breakdown of fats or glycogen
What is steatosis?
Fatty liver
What is steatohepatitis?
Fatty liver with inflammation
What happens in steatohepatitis?
Neutrophil infiltration
Leads to fibrosis, cirrhosis (buildup of scar tissue)
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
What is the recommended limit for alcohol unit consumption weekly?
14 units preferably over 3 days
What chart is used to determine level of alcohol dependence?
FAST/AUDIT
What are the physical findings in alcohol related pathologies like steatosis and steatohepatitis?
Majority none until advanced liver disease
Give 6 signs of chronic liver disease
- spider naevi
- palmar erythema
- gynaecomastia
- loss of axillary and pubic hair
- ascites
- encephalopathy
What can also indicate alcoholic liver damage?
Jaundice - late stage
Muscle wasting - weight loss - cachexia
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
Name 2 other lab results found
Macrocytosis
Thrombocytopenia (low platelets)
Name another investigation that can be done in liver disease
USS fatty liver
can also do liver biopsy
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
