alcohol related liver disease

Question 1

damage of alcohol abuse on the liver

Answer 1

Question 2

who is more likely to suffer from alcohol related health problems

Answer 2

people living in the most deprived area

Question 3

what type of liver is this

Answer 3

healthy

Question 4

what type of liver is this

Answer 4

fatty liver

Question 5

what type of liver is this

Answer 5

cirrhosis

Question 6

alcoholic fatty liver

Answer 6

most heavy drinkers will have fatty liver

20% progress to cirrhosis

alcohol abstinence improves fatty liver to normal

Question 7

acute alcoholic hepatitis

Answer 7

Alcohol intake > 8u / day

present with jaundice with Bilirubin > 80mg/dl

No other aetiology for Liver inflammation

Very high Mortality / No specific treatment yet

Question 8

alcoholic hepatitis GAHS score

Answer 8

Question 9

GAHS ≥9

Answer 9

30 day mortality - 48% w/o steroids, 22% w/ steroids

84 day mortality - 62% w/o steroids, 41% w/ steroids

Question 10

ARLD and hospital admission

Answer 10

1 person admitted w/ ARLD/day
Age at presentation is going down
Mean length of stay is 9 days
1 death every 4.5 days at ARI
Mean age at dying 58

Question 11

alcohol and malnutrition

Answer 11

60 % of chronic abusers have malnutrition

Most of the calories is from alcohol - no vitamins, proteins, fat

alcohol needs lots of vitamins for digestion

Total energy intake is reduced

• Nausea & Vomiting
• Abdo pain
• Diarrhoea

lots of pts are underweight and have muscle wasting, also osteoporosis if they are smokers

Question 12

mortality in alcoholic cirrhosis

Answer 12

75% die of Liver decompensation - don’t synthesise protein

20-25% Hepatocellular cancer sequelae - can block portal vein and hepatic vein

Question 13

ARLD and liver transplantation

Answer 13

<50 % 2 year survival without Transplant (when they present w/ cirrhosis and continue to drink)

MDT and holistic involvement

ARLD is the most common indication

• Resistant complications of Cirrhosis
• Jaundice
• Ascites
• Encephalopathy
• Coagulopathy

reduced incidence of hepatocellular cancer in transplant pts

cancer can be an indication for transplant as long as pts are engaging in services and remain abstinent for ≥6mths

Question 14

alcohol and teenagers

Answer 14

Cirrhosis is rare in Teenagers

Deranged LFTs are common especially in Obese teenagers

Exposure to Alcohol <14 yrs

• Strongly associated with later alcohol abuse & dependence
• (RR 2.3-4.0)

Question 15

LFT - alcohol use

Answer 15

raised MCV
low urea
reversed ALT:AST ratio
raised GGT

confirm w/ hx - don’t automatically base on alcohol use just on LFT!