Alcohol related diseases

Question 1

What are the common symptoms of ALD?

Answer 1

• Jaundice
• Muscle wasting

Do not show up until advanced

Question 2

Tests for ALD

Answer 2

Blood tests:
Gamma GT
macrocytosis: increase in size of RBCs without increase in Hb content 
Thrombocytopenia: low platelet count 
ADT/ALT>2

Question 3

Consequences of ALD?

Answer 3

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

Question 4

How does alcohol damage the liver?

Answer 4

• 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

Question 5

NAFLD and NASH

Answer 5

Non-alcoholic fatty liver disease
Non-alcoholic steato-hepatiits

Usually caused by diabetes and hypercholesteremia

Question 6

Steatohepatitis

Answer 6

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

Question 7

How is alcohol consumption questioned?

Answer 7

• Take history
• Use CAGE questions
• Fast/audit questionnaire about alcohol intake

Question 8

CAGE questions

Answer 8

• 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)

Question 9

Signs of alcohol liver disease

Answer 9

• Spider Naevi
• Palmar erythema
• Gychonomastia
• Loss of pubic/axillary hair
• Ascites

Question 10

How is hepatic encephalopathy related to ALD

Answer 10

Associated with liver failure which is usually associated with ALD.
Not direct consequence

Question 11

Hepatic encephalopathy pathology

Answer 11

• Due to the build up of Ammonia in the brain

- Ammonia is usually broken down into Urea in the liver

Question 12

Common reasons for levels of ammonia to increase in the blood?

Answer 12

• Infection
• Drugs
• Constipation
• GI bleed
• Electrolyte disturbance

Question 13

How do constipation and GI bleeds lead to an increase in Ammonia ?

Answer 13

Blood and faeces break down into ammonia which is then reabsorbed into portal circulation

Question 14

Hepatic encephalopathy treatment?

Answer 14

• Clear out the bowel (laxatives, enemas)
• Antibiotics
• ITU
• airway support
• NG tube

Question 15

How is hepatic encephalopathy graded?

Answer 15

1=mild confusion

4= coma

Question 16

Spotaneous bacterial peritonitis

Answer 16

Infection of the peritoneum which presents with ascots

Question 17

Symptoms of SBP?

Answer 17

abdominal pain

• Rigors, night sweats
• signs of renal damage
• sepsis, tachycardia, fever

Question 18

Investigations for SBP?

Answer 18

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

Question 19

Treatment of SBP

Answer 19

• IV antibiotics
• Ascite drainage
• IV albumin infusion

Question 20

Decompensated liver disease

Answer 20

When damage to liver is so severe it can no longer compensate and symptoms begin to occur

Question 21

Test for decompensated liver?

Answer 21

Low albumin

Raised prothrombin time i.e. time it takes the liver to make clotting factors

Question 22

Alcoholic hepatitis treatment

Answer 22

• Treat complications e.g. infection, encephalopathy
• Stop alcohol
• Steroids
• Balance nutrition
• Airway protection
• Supportive care
• Protection against GI bleeds

Question 23

How to manage diet of someone with alcoholic hepatitis?

Answer 23

Need to increase calorie intake.

Need to arrange meeting with a dietician

Question 24

Diagnosis for alcoholic hepatitis?

Answer 24

• Low albumin
• Raised INR
• Raised bilirubin: swollen liver will prevent it from being released
• Raised Gamma GT
• Alcohol history
• Scan for cancers