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The Alimentary Canal > Alcohol Related Liver Disease > Flashcards

Alcohol Related Liver Disease Flashcards

1
Q

Explain the oxidative metabolism of alcohol

A

Ethanol broken down by alcohol dehydrogenase into acetaldehyde
Acetaldehyde is toxic
Can be broken down into acetate
Build up of acetaldehyde can be damaging

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2
Q

What happens when acetaldehyde is saturated?

A

More metabolic pathways become involved
These can also become saturated

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3
Q

What can alcohol damage lead to in the liver?

A

Steatosis
Steatohepatitis

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4
Q

What is steatosis?

A

Fatty liver

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5
Q

What is steatohepatitis?

A

Fatty liver with inflammation
Neutrophil infiltrate
Can lead to fibrosis and cirrhosis

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6
Q

What is FAST/AUDIT?

A

Fast alcohol screening tool
Test to give score -
On test 1, if more than 3 then fast positive
On test 2, full score calculated

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7
Q

Explain FAST/AUDIT scoring

A

0-7 low risk
8-15 increasing risk
16-19 higher risk
20+ then possible dependence

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8
Q

What are the physical findings of alcoholic liver disease?

A

Majority no physical findings until advanced liver disease
Jaundice
Muscle wasting due to malnutrition
Signs of CLD

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9
Q

What are the signs of chronic liver disease?

A

Spider naevi, palmar erythema, gynaecomastia, loss of axillary and pubic hair, ascites and encephalopathy

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10
Q

What lab work can be done for alcoholic liver disease?

A

Aspartate amino transferase (AST) more than amino transferase (ALT) ratio more than 2
Raised gamma GT
Microcytosis
Thrombocytopenia - low platelets

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11
Q

What will ultrasound show for alcoholic liver disease?

A

Fatty liver

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12
Q

Explain the grading of hepatic encephalopathy

A

1 is mild confusion
4 is coma

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13
Q

What are the causes of hepatic encephalopathy?

A

Infection, drugs, constipation, GI bleed and electrolyte disturbance

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14
Q

What should be excluded from diagnosis when patient has hepatic encephalopathy?

A

Infection, hypoglycaemia and intra cranial bleed

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15
Q

What is the treatment for hepatic encephalopathy?

A

Bowel clear out, lactulose and enemas
Antibiotics even if infection is not obvious
Supportive - airway support, IV, nasogastric tube

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16
Q

What is spontaneous bacterial peritonitis?

A

Infection of ascitic fluid in the abdomen. It is one of the most frequently encountered bacterial infections in patients with cirrhosis

17
Q

What are the presentation of spontaneous bacterial peritonitis?

A

Abdominal pain, fever, rigors, renal impairment and signs of sepsis

18
Q

What is the investigation of spontaneous bacterial peritonitis?

A

Ascitic tap - fluid protein, glucose levels, culture and WCC

19
Q

Explain the results of spontaneous bacterial peritonitis on ascitic tap

A

Neutrophil count is more than 0.25x10^9/L
Protein is more than 25g/l

20
Q

What is the treatment for spontaneous bacterial peritonitis?

A

IV antibiotics
Ascitic fluid drainage
IV albumin infusion

21
Q

How does IV albumin infusion help spontaneous bacterial peritonitis?

A

Albumin increases vascular volume which reduces recurrence, improves kidney function and reduces septic process

22
Q

What is the presentation of alcoholic hepatitis?

A

Jaundice
Encephalopathy
Infection
Decompensated hepatic function

23
Q

What shows decompensated hepatic function?

A

Low albumin and raised prothrombin time/INR

24
Q

What factors help diagnose alcoholic hepatitis?

A

Raised bilirubin
Raised GGT and AlkP
Alcoholic history

25
Q

What is the prognosis of alcoholic hepatitis?

A

40% mortality
If severe then can be up to 90%

26
Q

What is the treatment for alcoholic hepatitis?

A

Supportive
Treat the infection, encephalopathy and alcohol withdrawal
Protect against GI bleeding
Airway Protection/ ITU care

27
Q

When are steroids given in alcoholic hepatitis?

A

Only if gradin shows severe
Glasgow Alcoholic hepatitis score of more than 9
Maddreys discriminant function more than 32

28
Q

Describe the nutritional treatment of alcoholic hepatitis

A

frequent feeds and high energy requirement
Thiamine (Vitamin B)

29
Q

What is the prognosis of alcoholic hepatitis?

A

Dependant on alcohol consumption
Steatohepatitis leads to cirrhosis
If decompensating liver - 70% mortality in 5 years

30
Q

What is NAFLD and NASH?

A

Non alcoholic fatty liver disease
Non alcoholic steatohepatitis

31
Q

What are some causes of a fatty liver?

A

Obesity
Diabetes
Hypercholesterolaemia
(alcohol)

32
Q

How many cases of steatohepatitis causes cirrhosis?

A

1/4

33
Q

How does non alcoholic steatohepatitis present?

A

Asymptomatic
Raised alanine amino transferase
Fatty liver on USS and liver biopsy

34
Q

What is the treatment for steatohepatitis?

A

Weight loss and exercise

The Alimentary Canal (33 decks)

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