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Gastrointestinal Pathology > Alcohol Related Disease > Flashcards

Alcohol Related Disease Flashcards

1
Q

Effects of alcohol on the liver

A

Encephalopathy
Spontaneous bacterial peritonitis
Alcoholic hepatitis

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2
Q

Which gender metabolises alcohol slower?

A

Women

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3
Q

If you have cirrhosis or liver disease, what does this mean when you consume alcohol?

A

You dont cope with acute alcohol

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4
Q

What is the toxic carcinogen of alcohol?

A

Acetaldehyde

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5
Q

Pathology of alcohol on the liver

A

Steatosis

Steatohepatitis

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6
Q

Definition of steatosis

A

Fatty Liver

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7
Q

Pathology of steatosis

A

Interruption to lipid metabolism and so fat deposited in the liver

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8
Q

Definition of steatohepatitis

A

Fatty liver with inflammation

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9
Q

Pathology of steatohepatitis

A

Neutrophil infiltration
Neutrophils cause cell damage and death
Fibrosis and cirrhosis

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10
Q

What questionnaires can be done in respect to alcohol?

A

CAGE

FAST/AUDIT

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11
Q

What are the 4 dependency questions of CAGE?

A

Have you ever felt the need to cut down?
Have you ever been annoyed by the critism of your drinking?
Have you ever felt guilty about your drinking?
Do you need an eye opener?

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12
Q

What does FAST/AUDIT identify?

A

Those at risk of dependent drinking

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13
Q

What are the questions of FAST?

A

How often have you had 6 female or 8 male or more unit in a single occasion in the last year?
How often in the last year have you failed to do what was normally expected from you because of your drinking?
How often during the last year have you been unable to remember what happened the night before because you had been drinking?
Has a relative or friend, doctor or other health worked been concerned about your drinking or suggested that you cut down?

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14
Q

Scoring of FAST

A

0, 1 or 2 on first question continue to the next questions
3 or 4 on 1st question - stop here
Overall score of 3 = FAST POSITIVE
Complete remaining audit questions

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15
Q

What are the AUDIT questions?

A

How often do you have a drink containing alcohol?
How many units of alcohol do you drink on a typical day when you are drinking?
How often during the last year have you found out you were not able to stop drinking once you had started?
How often during the last year have you needed an alcoholic drink in the morning to get yourself going after a heavy drinking session?
How often during the last year have you had a feeling of guilt or remorse after drinking?
Have you or somebody been injured as a result of your drinking?

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16
Q

Scores of AUDIT

A

0 - 7 = lower risk
8 - 15 = increasing risk
16 - 19 = higher risk
20 + possible dependence

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17
Q

Physical findings of alcoholic liver disease

A 
Majority no findings until advanced liver disease
Signs of chronic liver disease
- spider naevi
- palmar erythema
- gynaecomastia 
- loss of axillary and pubic hair 
- ascites
- encephalopathy
Jaundice
Muscle wasting
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18
Q

What lab results can be indicative of alcohol use?

A

AAT > ALT
Raised GGT
Macrocytosis
Thrombocytopenia

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19
Q

Once you are cirrhotic, are you are at risk of what?

A

Liver failure

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20
Q

If ammonia cannot be processed properly due to a damaged liver, what is the concern as it can cross what?

A

The blood brain barrier

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21
Q

Grading of hepatic encephalopathy

A

1 - 4
Grade 1 = mild confusion
Grade 4 = coma

22
Q

Causes of hepatic encephalopathy

A 
Infection 
Drugs
Constipation 
GI bleed
Electrolyte disturbance
23
Q

How can constipation cause hepatic encephalopathy?

A

Urea usually passed out but if constipated then you can reabsorb the ammonia which the liver cannot deal with

24
Q

What needs to be excluded when have suspected hepatic encephalopathy?

A

Infection
Hypoglycaemia
Intra-cranial bleeding e.g. due to falling over

25
Q

Treatment of hepatic encephalopathy

A 
Bowel clear out
- lactulose
- enemas
Antibiotics
Supportive
- ITU, airway support
- NG tube for meds
LACTULOSE
- inhibits production of ammonia in the intestine
26
Q

What must you have before you develop spontaneous bacterial peritonitis?

A

Ascites

27
Q

Presentation of spontaneous bacterial peritonitis

A 
Abdominal pain 
Fever
Rigors
Renal impairment 
Signs of 
- sepsis
- tachycardia
- temperature
28
Q

What would an ascitic tap of spontaneous bacterial peritonitis look like?

A

Low fluid protein
High glucose
Cultures
White cell content

29
Q

Lab features of spontaneous bacterial peritonitis

A

Neutrophil count > 0.25 x109 - HIGH

Protein < 25 LOW

30
Q

Treatment of spontaneous bacterial peritonitis

A

IV antibiotics
Ascitic fluid drainage
IV albumin infusion (20% ALBA)

31
Q

Presentation of alcoholic hepatitis

A 
Jaundice
Encephalopathy 
Infection common 
Decompensated hepatic function 
- low albumin 
- raised PT 
Often cirrhotic but not always
32
Q

Investigations of alcoholic hepatitis

A

Raised bilirubin
Raised GGT and ALP
Alcohol history

33
Q

Prognosis of alcoholic hepatitis

A

40% mortality

If severe up to 90% mortality

34
Q

Treatment of alcoholic hepatitis

A 
Supportive
Treat infection 
Treat encephalopathy 
Treat alcohol withdrawal 
Protect against GI bleeding
Airway protection/ITU care 
Steriods
- only if Glasgow alcoholic hepatitis score > 9
Nutritional support
- thiamine (vit B12 dietary supplement)
- frequent feeds as high energy requirement
35
Q

What does the Glashow alcoholic hepatitis score look at?

A 
Age
WCC
Urea
INR
Bilirubin
36
Q

What % of patients with alcoholic hepatitis are malnourished? What % are severely malnourished?

A

100%

33 % severely

37
Q

What does prognosis of alcoholic hepatitis depend on?

A

Abstinence

Ongoing alcohol consumption

38
Q

What does steatohepatitis lead to?

A

Cirrhosis

39
Q

5 year mortality of alcoholic hepatitis if present with any sign of decompensating liver disease

A

70%

40
Q

1 year mortality of alcoholic hepatitis if present with encephalopathy

A

64%

41
Q

What % of the population has a fatty liver?

A

25 - 40%

42
Q

Risk factors for a fatty liver

A

Obesity
DM
Hypercholesteraemia
Alcohol

43
Q

What would be raised in steatohepatitis?

A

AAT

44
Q

Investigations of steatohepatitis

A

LFTs
USS
Liver Biopsy

45
Q

Treatment of steatohepatitis

A

Weight loss

Exercise

46
Q

Treatment of hepatic encephalopathy

A

Treat underlying cause
Oral lactulose first line
Add rifampicin for secondary prrophylaxis of HE

47
Q

How does lactulose treat HE?

A

Promotes the excretion of ammonia and increases the metabolism of ammonia by gut bacteria

48
Q

Management of severe alcoholic hepatitis

A

Prednisolone

49
Q

Metabolic ketoacidosis with normal or low glucose would make you think of what?

A

Alcohol

50
Q

What is used for secondary prophylaxis of HE?

A

Lactulose and rifampicin

Gastrointestinal Pathology (26 decks)

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