Alcohol Related Disease

Question 1

What is the effect of alcohol on the liver?

Answer 1

Direct toxicity

Question 2

Which gender metabolises alcohol slower?

Answer 2

Women

Question 3

Why does alcohol affect people differently?

Answer 3

Depends on genetics and how we metabolise alcohol

Question 4

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

Answer 4

Acetaldehyde broken down to acetate

Question 5

When the liver is metabolising alcohol what is interrupted?

Answer 5

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

Question 6

What is steatosis?

Answer 6

Fatty liver

Question 7

What is steatohepatitis?

Answer 7

Fatty liver with inflammation

Question 8

What happens in steatohepatitis?

Answer 8

Neutrophil infiltration

Leads to fibrosis, cirrhosis (buildup of scar tissue)

Question 9

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

Answer 9

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

Question 10

What is the recommended limit for alcohol unit consumption weekly?

Answer 10

14 units preferably over 3 days

Question 11

What chart is used to determine level of alcohol dependence?

Answer 11

FAST/AUDIT

Question 12

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

Answer 12

Majority none until advanced liver disease

Question 13

Give 6 signs of chronic liver disease

Answer 13

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

Question 14

What can also indicate alcoholic liver damage?

Answer 14

Jaundice - late stage

Muscle wasting - weight loss - cachexia

Question 15

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

Answer 15

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

Question 16

Name 2 other lab results found

Answer 16

Macrocytosis

Thrombocytopenia (low platelets)

Question 17

Name another investigation that can be done in liver disease

Answer 17

USS fatty liver

can also do liver biopsy

Question 18

What is hepatic encephalopathy?

Answer 18

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

Question 19

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

Answer 19

Graded 1-4
1 = mild confusion
4 = coma

Question 20

Name possible causes of hepatic encephalopathy

Answer 20

Infection 
Drugs
Constipation
GI bleed
Electrolyte disturbance

Question 21

What is important to exclude in hepatic encephalopathy?

Answer 21

Infection
Hypoglycaemia
Intra-Cranial bleed

Question 22

Treatment for hepatic encephalopathy? (3 types)

Answer 22

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

Question 23

What is spontaneous bacterial peritonitis?

Answer 23

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

Question 24

Give some signs of spontaneous bacterial peritonitis?

Answer 24

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

Question 25

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

Answer 25

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

Question 26

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

Answer 26

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

Question 27

Treatment for SBP? (3 types)

Answer 27

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

Question 28

Give some presenting features of alcoholic hepatitis

Answer 28

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

Question 29

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

Answer 29

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

Question 30

Prognosis for alcoholic hepatitis?

Answer 30

40% mortality | if severe - up to 90%

Question 31

Treatment for alcoholic hepatitis? (lots)

Answer 31

- 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

Question 32

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

Answer 32

Steroids

Question 33

Why is nutrition part of the treatment for alcoholic hepatitis?

Answer 33

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

Question 34

What is the nutritional support for AH?

Answer 34

Frequent feeds | High energy requirement

Question 35

What is prognosis of AH dependant on?

Answer 35

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)

Question 36

2 types of 'fatty liver'?

Answer 36

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

Question 37

What is fatty liver linked with?

Answer 37

Obesity Diabetes Hypercholesterolaemia (alcohol)

Question 38

What 2 things cause steatohepatitis (pathologically)

Answer 38

Fat + inflammation

Question 39

What is fatty liver histologically similar to?

Answer 39

Alcohol induced damage

Question 40

Steatohepatitis can be asymptomatic; what 3 tests diagnose it?

Answer 40

Raised AAT Fatty liver on USS Liver biopsy

Question 41

Treatment for steatohepatitis?

Answer 41

Weight loss | Exercise

Question 42

What can alcohol induced steatosis lead to?

Answer 42

Alcoholic hepatitis

Question 43

When is alcoholic hepatitis treated with oral corticosteroids?

Answer 43

When maddrey's discriminant >32