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*GI System - Pathology > Alcohol Related Disease > Flashcards

Alcohol Related Disease Flashcards

1
Q

What is the effect of alcohol on the liver?

A

Direct toxicity

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2
Q

Which gender metabolises alcohol slower?

A

Women

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3
Q

Why does alcohol affect people differently?

A

Depends on genetics and how we metabolise alcohol

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4
Q

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

A

Acetaldehyde broken down to acetate

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5
Q

When the liver is metabolising alcohol what is interrupted?

A

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

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6
Q

What is steatosis?

A

Fatty liver

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7
Q

What is steatohepatitis?

A

Fatty liver with inflammation

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8
Q

What happens in steatohepatitis?

A

Neutrophil infiltration

Leads to fibrosis, cirrhosis (buildup of scar tissue)

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9
Q

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

A 
Beer = half pint 
Wine = small glass
Spirits = single measure
Sherry = small glass
Aperitif = single measure
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10
Q

What is the recommended limit for alcohol unit consumption weekly?

A

14 units preferably over 3 days

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11
Q

What chart is used to determine level of alcohol dependence?

A

FAST/AUDIT

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12
Q

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

A

Majority none until advanced liver disease

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13
Q

Give 6 signs of chronic liver disease

A
  • spider naevi
  • palmar erythema
  • gynaecomastia
  • loss of axillary and pubic hair
  • ascites
  • encephalopathy
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14
Q

What can also indicate alcoholic liver damage?

A

Jaundice - late stage

Muscle wasting - weight loss - cachexia

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15
Q

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

A

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

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16
Q

Name 2 other lab results found

A

Macrocytosis

Thrombocytopenia (low platelets)

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17
Q

Name another investigation that can be done in liver disease

A

USS fatty liver

can also do liver biopsy

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18
Q

What is hepatic encephalopathy?

A

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

19
Q

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

A

Graded 1-4
1 = mild confusion
4 = coma

20
Q

Name possible causes of hepatic encephalopathy

A 
Infection 
Drugs
Constipation
GI bleed
Electrolyte disturbance
21
Q

What is important to exclude in hepatic encephalopathy?

A

Infection
Hypoglycaemia
Intra-Cranial bleed

22
Q

Treatment for hepatic encephalopathy? (3 types)

A
  • Bowel clear out (lactulose, enemas)
  • Abx
  • Supportive (ITU, airway support, NG tube for meds)
23
Q

What is spontaneous bacterial peritonitis?

A

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

24
Q

Give some signs of spontaneous bacterial peritonitis?

A
  • Abdominal pain
  • Fever, rigors
  • Renal impairment
  • Sepsis, tachycardia, temperature
25
Q

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

A

Ascitic tap !

  • Fluid protein and glucose levels
  • Cultures
  • White cell content
26
Q

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

A

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

27
Q

Treatment for SBP? (3 types)

A

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

28
Q

Give some presenting features of alcoholic hepatitis

A

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

29
Q

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

A
  • Raised bilirubin
  • Raised GGT and AlkP
  • Alcohol history
    (exclude other causes)
30
Q

Prognosis for alcoholic hepatitis?

A

40% mortality

if severe - up to 90%

31
Q

Treatment for alcoholic hepatitis? (lots)

A
  • 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
32
Q

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

A

Steroids

33
Q

Why is nutrition part of the treatment for alcoholic hepatitis?

A

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

34
Q

What is the nutritional support for AH?

A

Frequent feeds

High energy requirement

35
Q

What is prognosis of AH dependant on?

A

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)

36
Q

2 types of ‘fatty liver’?

A 
Steatosis = fatty liver, non alcoholic fatty liver (NAFLD)
Steatohepatitis = non alcoholic steatohepatitis (NASH)
37
Q

What is fatty liver linked with?

A

Obesity
Diabetes
Hypercholesterolaemia
(alcohol)

38
Q

What 2 things cause steatohepatitis (pathologically)

A

Fat + inflammation

39
Q

What is fatty liver histologically similar to?

A

Alcohol induced damage

40
Q

Steatohepatitis can be asymptomatic; what 3 tests diagnose it?

A

Raised AAT
Fatty liver on USS
Liver biopsy

41
Q

Treatment for steatohepatitis?

A

Weight loss

Exercise

42
Q

What can alcohol induced steatosis lead to?

A

Alcoholic hepatitis

43
Q

When is alcoholic hepatitis treated with oral corticosteroids?

A

When maddrey’s discriminant >32

*GI System - Pathology (8 decks)

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