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2ND YEAR SYSTEMS: GI > Alcohol related disease > Flashcards

Alcohol related disease Flashcards

1
Q

What is Steatosis?

A

the earliest, most common response of the liver to excessive alcohol consumption

excess lipids within the liver tissue + disrupted metabolism

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2
Q

What are the major ethanol metabolising enzymes called? (2)

A

alcohol dehydrogenase

cytochrome P450 2E1

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3
Q

What is steatohepatitis?

A

More serious condition that often continues on from steatosis

it is fatty liver with an inflammatory response too

  • have neutrophil infiltration
  • fibrosis, cirrhosis
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4
Q

What is CAGE? Used in history taking - alcohol consumption

A

Questions to find out if person is dependent on alcohol- can have alcohol damage without dependency

Cut down
Annoyed
Guilty
Eye opener (drink to wake you up in morning/ steady nerves)

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5
Q

What are the clinical signs of chronic liver disease? (8)

A 
Spider naevi
palmar erythema
gynaecomastia
loss of axillary and pubic hair
ascites
encephalopathy - brain damage/disease
Jaundice 
muscle wasting - alcohol consumes your diet then reduced nutrients and so energy has to be taken from muscles
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6
Q

Lab tests to test liver function

A

Aspartate Amino Transferase (AAT) > alanine Amino Transferase (ALT) Ratio >2 indicates alcoholic liver disease

Raised Gamma Glutamyl Transferase - indicates damaged liver but could be many causes

Macrocytosis - enlarged RBC

Thrombocytopenia (low platelets)

if it’s to test synthetic liver function then prothrombin time - liver produces majority of coagulation proteins needed in blood clotting cascade. Severe liver injury leads to reduction of liver synthesis of clotting factors and consequently prolonged PT

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7
Q

What is hepatic Encephalopathy?

A

changes in the brain that occur in patients with advanced, acute or chronic liver disease

not unique to liver disease but feature of liver failure

Graded 1-4

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8
Q

Grade 1 Hepatic encephalopathy

A

mild confusion

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9
Q

Grade 4 Hepatic encephalopathy

A

Coma

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10
Q

Causes of Hepatic Encephalopathy (5)

A

increased NH3 due to liver not processing toxins efficiently - crosses B.B.B

Infection
Drugs
Constipation
GI Bleed - varicses, ulcers due to high pressure - proteins leaking into gut - NH3
Electrolyte Disturbance
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11
Q

Treatment for Hepatic Encephalopathy (3)

A

Bowel clear out - lactulose (oral or enema) - dramatically reduces amount of NH3 in system

Antibiotics - tend to have infection somewhere

Supportive (confusion, coma etc) - (intensive treatment unit) ITU, airway support, nasogastric tube for meds

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12
Q

How does lactulose help with Hepatic Encephalopathy

A

reduces the amount of NH3 in the blood of patients with liver disease. It draws NH3 from the blood into the colon where it is removed from the body

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13
Q

What symptoms can a spontaneous bacterial peritonitis cause? (4)

A

liver failure - usually presence of ascites - extreme distension - can become infected and cause peritonitis

abdominal pain

fever, rigors

renal impairment

signs of sepsis - tachycardia, temperature

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14
Q

What is an Ascitic Tap?

A

medical procedure where a needle is used to drain ascitic fluid from the abdomen

fluid protein and glucose levels can be measured

cultures

white cell content important to indicate whether infection is present

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15
Q

What neutrophil count or protein level would you expect for a spontaneous bacterial peritonitis?

A

Neutrophil Count >0.25x109 /L

Protein <25g/L

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16
Q

Treatment for spontaneous bacterial peritonitis? (3)

A

IV antibiotics
Ascitic fluid drainage
IV albumin infusion

some may get dialysed temporarily to treat infection

17
Q

How does a patient present with alcoholic hepatitis

A

Jaundice

Encephalopathy

Infection common

Decompensated hepatic function

18
Q

What indicates a decompensated hepatic function

A

Low albumin and raised prothrombin time (becomes prolonged as liver doesn’t release clotting factors)

19
Q

What is the prognosis like for alcoholic hepatitis?

A

poor
40% mortality
90% if severe

20
Q

Treatment for alcoholic hepatitis?

A 
supportive - abstinence + nutrition
treat infection
treat encephalopathy 
treat alcohol withdrawal
airway protection/ ITU care
21
Q

Glasgow alcohol hepatitis grading score - what is it? what does it take into consideration?

A

simple bedside tool to determine whether patient is high risk of severe alcoholic hepatitis - this is used over Maddrey’s

Age, WCC, Urea, INR, Bilirubin

score >9 means severe

22
Q

Treatment options for low risk (<32 MDF) alcoholic hepatitis?

A

Nutritional support - v important
100% patients with alcoholic hepatitis are malnourished, 33% severely

2 yr Survival 15% vs 70% if well nourished

Thiamine (vit B1)

Frequent Feeds, liver has high energy requirement

23
Q

Prognosis of mild/moderate alcoholic hepatitis

A

Dependant on abstinence or ongoing alcohol consumption

Having steatohepatitis and continuing to drink leads to liver cirrhosis but if you stop at mild/moderate injury then the liver is good at remodelling

24
Q

Steatosis and steatohepatitis can affect individuals who don’t drink excessively as well. What are 2 disease examples of this?

A

non alcoholic fatty liver

non alcoholic steatohepatitis

25
Q

Fatty liver disease is mostly associated with obesity - what factors related to obesity contribute to fatty liver?

A

diabetes
hypercholesterolaemia
alcohol - some alcoholic patients are also obese

26
Q

True or false: fatty liver mechanism is very similar to alcohol

A

True
histology similar to alcohol induced damage
1/4 people with non alcoholic steatohepatitis will develop cirrhosis

27
Q

genetic variation: alcohol processing in the liver

A

some are better at processing alcohol than others due to genetic makeup

28
Q

What are some outcomes of alcohol interrupting normal metabolism

A 
hypoglycaemia (gluconeogenesis knocked off)
acidosis
ketosis (interrupted CAC)
excess lipids 
NADH + H+
29
Q

How is alcoholic hepatitis diagnosed?

A 
no simple diagnostic test 
check bilirubin levels (raised)
GGT and AlkP (raised)
Alcohol history 
Exclude other causes like gallstones, viral hepatitis
30
Q

treatment for high risk patient ie severe alcoholic hepatitis?

A

oral steroids - only given for severe disease due to risk of GI bleed etc

31
Q

prognosis for severe alcoholic hepatitis?

A

very poor

with encephalopathy 64% die within 1 year

32
Q

tests for non-alcoholic steatohepatitis?

A

Alanine ratio
USS
biopsy

33
Q

What is Spontaneous bacterial peritonitis?

A

a common complication of cirrhosis

infection in ascitic fluid

2ND YEAR SYSTEMS: GI (38 decks)

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