Alcohol Related Disease Flashcards
Diseases from what system have the greatest mortality compared to the rest?
Liver diseases
Do woman or men metabolise alcohol slower?
Women
What causes a variation in alcohol toxicity?
Genetic variation
What is the pathway of ethanol metabolism?
Ethanol -> Acetaldehyde -> Acetate
What enzyme converts ethanol into acetaldehyde?
Alcohol dehydrogenase
What enzyme converts acetaldehyde into acetate?
Acetaldehyde dehydrogenase
What effects does alcohol have on the liver?
Steatosis (fatty liver)
Steatohepatitis (fatty liver with inflammation)
What does steatosis describe?
Process describing abnormal retention of lipids within a cell or organ
What is steatohepatitis?
Type of fatty liver disease characterised by inflammation of the liver with concurrent fat accumulation in the liver
What are causes of steatohepatitis?
Neutrophil infiltration
Fibrosis, cirrhosis (build up of scar tissue)
When taking a history to do with alcohol liver disease what acrynm should be remembered?
CAGE:
Have you ever 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 EYEOPENER
How much beer, wine and spirits is 1 unit of alcohol?
Half pint of beer
Small glass of wine
Single measure of spirit
What questionaire is used to determine alcoholism?
FAST questionaire
A score of what is FAST positive on a FAST questionaire?
3 or more
What do you do if someone gets a score of 3 or more on a FAST questionaire?
Complete remaining audit questions to obtain a full AUDIT score
When doing a full AUDIT score on a FAST questionaire, what is considered to be increasing risk, higher risk and possible dependence?
8-15 is increasing risk
16-19 is higher risk
20+ is possible dependence
What are physical findings for alcoholic liver disease?
Majority have no physical findings until advanced liver disease
Signs of chronic liver disease (spider naevi, palmar erythema, gynaemocastia, loss of axillary and pubic hair, ascites, encephalopathy)
Jaundice
Muscle wasting
What can be seen in lab tests for alcoholic liver disease?
Asparate amino transferase (AAT) > alanine amino transferase (ALT), ratio > 2
Raised gamma glutamyl transferase
Macrocytosis
Thrombocytopenia (low platelets)
What imaging is done to look for a fatty liver?
Ultrasound scan
What is hepatic encephalopathy?
Decline in brain function that occurs due to severe liver disease
How is the severity of hepatic encephalopathy graded?
1 to 4
Where 1 is mild confusion and 4 is a coma
What is the aetiology of hepatic encephalopathy?
Infection
Drugs
Constipation
GI bleed
Electrolyte disturbance
What should be excluded before diagnosing hepatic encephalopathy?
Infection
Hypoglycaemia
Intra-cranial bleed
What is the treatment of hepatic encephalopathy?
Bowel clear out, lactulose, enemas
Antibiotics
Supportive (ITU, airway support, NG tube for meds)
What does SBP stand for?
Spontaneous bacterial peritonitis
What is spontaneous bacterial peritonitis (SBP)?
Development of bacterial infection in the peritoneum, despite the absence of obvious source for the infection
What are symptoms and signs of spontaneous bacterial peritonitis?
Abdominal pain
Fever, rigors
Renal impairment
Signs of sepsis such as tachycardia and temperature
What investigations should be done for spontaneous bacterial peritonitis (SBP)?
Ascitic tap:
fluid protein and glucose levels
cultures
white cell content
What is the neutrophil count for spontaneous bacterial peritonitis?
> 0.25 x 109/L
What is the protein level for spontaneous bacterial peritonitis?
< 25g/L
What is the treatment of spontaneous bacterial peritonitis?
IV antibiotics
Ascitic fluid drainage
IV albumin infusion (20% ALBA)
What is alcoholic hepatitis?
Inflammation of the liver caused by drinking alcohol
What is the presentation of alcoholic hepatitis?
Jaundice
Encephalopathy
Infection common
Decompensated hepatic function (low albumin and raised prothrombin time/INR)
What is required for a diagnosis of alcoholic hepatitis?
Raised bilirubin
Raised GGT and AlkP
Alcohol history
Exclude other causes
What is the prognosis of alcoholic hepatitis like?
Poor
40% mortality
If severe up to 90% mortality
What is the treatment for alcoholic hepatitis?
Supportive
Treat infection
Treat encephalopathy
Treat alcohol withdrawal
Protect against GI bleeding
Airway protection/ITU care
Steroids (only if graded severe, Glasgow alcoholic hepatitis score > 9)
Nutritional (they are malnourished, give thiamine)
What Glasgow alcoholic hepatitis score is required for steroids to be used as a treatment?
> 9
What does the Glasgow Alcoholic Hepatitis score consider?
Age
White cell count
Urea
INR
Billirubin
Other than the Glasgow Alcoholic Hepatitis score, what is another way of evaluating the severity of alcoholic hepatitis?
Maddrey’s discrimination function
What is the prognosis of alcoholic hepatitis dependent on?
Alcohol abstinence or ongoing consumption
What are the different kinds of fatty liver?
Steatosis (non-alcoholic fatty liver disease, NAFLD)
Steatohepatitis (non-alcoholic steatohepatitis, NASH)
What does NAFLD stand for?
Non-alcohlic fatty liver disease
What does NASH stand for?
Non-alcoholic steatohepatitis
What are risk factors for fatty liver?
Obesity
Diabetes
Hypercholesterolaemia
Alcohol
What percentage of people with fatty liver develop cirrhosis?
25%
What is the treatment for fatty liver?
Weight loss
Exercise
What is required to diagnose fatty liver?
Raised alanine amino transferase
Fatty liver on USS
Liver biopsy
