Alcohol related diseases Flashcards
What are the common symptoms of ALD?
- Jaundice
- Muscle wasting
Do not show up until advanced
Tests for ALD
Blood tests: Gamma GT macrocytosis: increase in size of RBCs without increase in Hb content Thrombocytopenia: low platelet count ADT/ALT>2
Consequences of ALD?
Steatosis: Fatty acid cannot be broken down- Interrupted lipid metabolism
Steatohepatitis: build up of fat in the liver which can lead to fibrosis and eventually cirrhosis
How does alcohol damage the liver?
- Alcohol is a toxin to the liver: leads to liver failure due to chronic exposure
- Interrupts many metabolic processes such as Gluconeogenesis and Lipid metabolism
NAFLD and NASH
Non-alcoholic fatty liver disease
Non-alcoholic steato-hepatiits
Usually caused by diabetes and hypercholesteremia
Steatohepatitis
Fatty build up in the liver which leads to fibrosis and eventually cirrhosis
Investigation:
- US
- Biopsy
- Raised ALT
Treat: weight loss, exercise, abstinence of alcohol
How is alcohol consumption questioned?
- Take history
- Use CAGE questions
- Fast/audit questionnaire about alcohol intake
CAGE questions
- do they ever feel the need to CUT down
- are they ANNOYED by critcism of drinking
- are they GUILTY about ther drinking
- do they need an EYEOPENER (morning drink)
Signs of alcohol liver disease
- Spider Naevi
- Palmar erythema
- Gychonomastia
- Loss of pubic/axillary hair
- Ascites
How is hepatic encephalopathy related to ALD
Associated with liver failure which is usually associated with ALD.
Not direct consequence
Hepatic encephalopathy pathology
- Due to the build up of Ammonia in the brain
- Ammonia is usually broken down into Urea in the liver
Common reasons for levels of ammonia to increase in the blood?
- Infection
- Drugs
- Constipation
- GI bleed
- Electrolyte disturbance
How do constipation and GI bleeds lead to an increase in Ammonia ?
Blood and faeces break down into ammonia which is then reabsorbed into portal circulation
Hepatic encephalopathy treatment?
- Clear out the bowel (laxatives, enemas)
- Antibiotics
- ITU
- airway support
- NG tube
How is hepatic encephalopathy graded?
1=mild confusion
4= coma
Spotaneous bacterial peritonitis
Infection of the peritoneum which presents with ascots
Symptoms of SBP?
abdominal pain
- Rigors, night sweats
- signs of renal damage
- sepsis, tachycardia, fever
Investigations for SBP?
Ascitic tap : drain inserted into gut to remove contents:
- Fluid protein and Glucose levels
- cultures
- White cell content
Positive when:
- Protein<25g/L
- Neutrophil count is> 0.25 x10^9
Treatment of SBP
- IV antibiotics
- Ascite drainage
- IV albumin infusion
Decompensated liver disease
When damage to liver is so severe it can no longer compensate and symptoms begin to occur
Test for decompensated liver?
Low albumin
Raised prothrombin time i.e. time it takes the liver to make clotting factors
Alcoholic hepatitis treatment
- Treat complications e.g. infection, encephalopathy
- Stop alcohol
- Steroids
- Balance nutrition
- Airway protection
- Supportive care
- Protection against GI bleeds
How to manage diet of someone with alcoholic hepatitis?
Need to increase calorie intake.
Need to arrange meeting with a dietician
Diagnosis for alcoholic hepatitis?
- Low albumin
- Raised INR
- Raised bilirubin: swollen liver will prevent it from being released
- Raised Gamma GT
- Alcohol history
- Scan for cancers
