Alcohol Related Disease

Question 1

What is steatosis? Steatohepatitis?

Answer 1

• Steatosis: Fatty Liver

- Steatohepatitis: fatty liver with inflammation

Question 2

What criteria are used to determine if a person is alcohol dependent?
Rough outline of how they’re scored?

Answer 2

• FAST & AUDIT
• FAST: score of 3 = fast positive.
• If FAST positive complete AUDIT questions
  Scoring:
• 8-15: increasing risk
• 16-19: Higher risk
• 20+ Possible dependence

Question 3

Signs of chronic liver disease?

Answer 3

• Spider Naevi
• Palmar erythema (reddish palms)
• Gynaecomastia
• Loss of axillary and pubic hair
• Ascites
• Encephalopathy
• Jaundice
• Muscle Wasting

Question 4

Investigations for suspected alcoholic liver disease?

Answer 4

• AST : ALT >2
• Raised Gamma Glutamyl Transferase (GGT)
• Macrocytosis (enlargement of RBC’s)
• Thrombocytopenia / Prothrombin Time
• USS fatty liver (fibroscan)

Question 5

What is hepatic encephalopathy a sign of? How is it graded?

Answer 5

• Liver failure
• Graded 1-4:
  1: mild confusion
  2: Coma

Question 6

Possible causes (DDx) for hepatic encephalopathy? (non-alcohol ones)

Answer 6

• Infection
• Drugs
• Constipation
• GI bleeding
• Electrolyte Disturbance (eg. hypoglycaemia)

Question 7

Treatment of Hepatic Encephalopathy?

Answer 7

• Bowel Clear out (enema / laxatives)
• Antibiotics
• BCAA’s
• Supportive (ITU etc.)

Question 8

What is Spontaneous Bacterial Peritonitis? Symptoms?

Answer 8

• Infection of ascitic fluid without any obvious cause
• Abdominal pain
• Fever, Rigors
• Renal Impairment
• Signs of: Sepsis, tachycardia, high temp.

Question 9

Investigations and treatment for Spontaneous Bacterial Peritonitis?

Answer 9

Investigations: Ascitic tap for:

• Fluid Protein and Glucose levels
• Culture
• White Cell content

Management:

• IV Antibiotics
• Ascitic fluid drainage
• IV albumin infusion (?)

Question 10

Presentation of alcohol hepatitis?

Answer 10

• Jaundice
• Encephalopathy
• Infection
• Decompensated hepatic function

Question 11

Investigations for suspected Alcohol Hepatitis?

Answer 11

• AST : ALT > 2
• Raised Bilirubin
• Raised GGT and ALP
• Alcohol history
• Exclusion of other causes…

Question 12

Treatment of Alcoholic Hepatitis?

Answer 12

• Steroids if Glasgow Alcoholic Hepatitis Score > 9
• Treat infection / encephalopathy
• Supportive care (thiamine / nourishment)
• Protect against GI bleeding / airway problems

Question 13

Investigations for suspected steatohepatitis?

Answer 13

• Bloods: ALT (alanine aminotransferase)
• Fatty liver on USS
• Liver biopsy

Question 14

Management of steatohepatitis?

Answer 14

• Weight loss & exercise

If unmanaged may lead to cirrhosis