Alcohol-Related Disease Flashcards
Describe steatosis and steatohepatitis.
- Steatosis: fatty liver
- Steatohepatitis: fatty liver with inflammation, neutrophil infiltration, fibrosis, cirrhosis
Describe the history taking of alcoholism.
CAGE;
- Have you felt the need to CUT down?
- Have you been ANNOYED by criticism of your drinking?
- Have you felt GUILTY about your drinking?
- Do you need an EYE-OPENER?
FAST/AUDIT;
- 4 questions (FAST) followed by 6 more (AUDIT) if FAST is positive (score >3)
- Score 8-15: increasing risk
- Score 16-19: higher dependence
- Score 20+: possible dependence
Describe the signs of chronic liver disease.
- Majority have no physical findings until advanced liver disease
- Spider naevi, palmar erythema, gynaecomastia, loss of axillary and pubic hair, ascites, encephalopathy
- Jaundice
- Muscle wasting
Describe the investigation of liver disease.
Labs;
- Aspartate aminotransferase (AAT) > alanine aminotransferase (ALT): ratio >2
- Raised gamma glutamyl transfuse
- Macrocytosis (enlargement of erythrocytes)
- Thrombocytopaenia
Scans;
- USS fatty liver
Describe hepatic encephalopathy and it’s aetiology.
- Liver failure
- Graded 1-4: 1 – mild confusion, 4 – coma
Causes;
- Infection
- Drugs
- Constipation
- GI bleed
- Electrolyte disturbance
Describe the differential diagnoses of hepatic encephalopathy.
- Infection
- Hypoglycaemia
- Intra-cranial bleed
Describe the treatment of hepatic encephalopathy.
- Bowel clear-out, lactulose, enemas
- Antibiotics
- Supportive: ICU, airway support, nasogastric tube for medication
Describe the presentation of spontaneous bacterial peritonitis.
- Abdominal pain
- Fever, rigors
- Renal impairment
- Signs of sepsis, tachycardia, temperature
Describe the investigation of spontaneous bacterial peritonitis.
Ascitic tap;
- Fluid protein and glucose levels
- Cultures
- White cell content
- Neutrophil count >0.25x10^9/L
- Protein <25g/L
- Exclude surgical causes of peritonitis
Describe the treatment of spontaneous bacterial peritonitis.
- IV antibiotics
- Ascitic fluid drainage
- IV albumin infusion (20% ALBA)
Describe the presentation of alcoholic hepatitis.
- Jaundice
- Encephalopathy
- Infection common
- Decompensated hepatic function: low albumin and raised prothrombin time/INR)
Describe the investigation of alcoholic hepatitis.
- Raised bilirubin
- Raised GGT and AlkP
- Alcohol history
- Exclude other causes
Describe the prognosis of alcoholic hepatitis.
- 40% mortality (up to 90% if severe)
- Dependent on abstinence or ongoing alcohol consumption
- Steatohepatitis –> cirrhosis
- Patient presents any sign of decompensating liver disease: 70% mortality in 5 years
- Presents with encephalopathy: 64% mortality in 1 year
Describe the treatment of alcoholic hepatitis.
- Supportive
- Treat infection
- Treat encephalopathy
- Treat alcohol withdrawal
- Protect against GI bleeding
- Airway protection/ICU care
- Steroids: only if grading severe, Glasgow Alcoholic Hepatitis Score >9
Maddreys discriminant function >32 (high mortality rate);
- Treat with oral steroids
- 4.6 x (prothrombin time – control PT) + bilirubin
Nutritional;
- 100% patients with alcoholic hepatitis are malnourished, 33% severely
- 2YS 15% vs. 70% if well nourished
- Thiamine
- Frequent feeds, high energy requirement
Describe non-alcohol related fatty liver disease (NAFLD).
- 25-40% population
- Obesity
- Diabetes
- Hypercholesterolaemia
- (Alcohol)
