Alcohol Related Liver Disease Flashcards
Explain the oxidative metabolism of alcohol
Ethanol broken down by alcohol dehydrogenase into acetaldehyde
Acetaldehyde is toxic
Can be broken down into acetate
Build up of acetaldehyde can be damaging
What happens when acetaldehyde is saturated?
More metabolic pathways become involved
These can also become saturated
What can alcohol damage lead to in the liver?
Steatosis
Steatohepatitis
What is steatosis?
Fatty liver
What is steatohepatitis?
Fatty liver with inflammation
Neutrophil infiltrate
Can lead to fibrosis and cirrhosis
What is FAST/AUDIT?
Fast alcohol screening tool
Test to give score -
On test 1, if more than 3 then fast positive
On test 2, full score calculated
Explain FAST/AUDIT scoring
0-7 low risk
8-15 increasing risk
16-19 higher risk
20+ then possible dependence
What are the physical findings of alcoholic liver disease?
Majority no physical findings until advanced liver disease
Jaundice
Muscle wasting due to malnutrition
Signs of CLD
What are the signs of chronic liver disease?
Spider naevi, palmar erythema, gynaecomastia, loss of axillary and pubic hair, ascites and encephalopathy
What lab work can be done for alcoholic liver disease?
Aspartate amino transferase (AST) more than amino transferase (ALT) ratio more than 2
Raised gamma GT
Microcytosis
Thrombocytopenia - low platelets
What will ultrasound show for alcoholic liver disease?
Fatty liver
Explain the grading of hepatic encephalopathy
1 is mild confusion
4 is coma
What are the causes of hepatic encephalopathy?
Infection, drugs, constipation, GI bleed and electrolyte disturbance
What should be excluded from diagnosis when patient has hepatic encephalopathy?
Infection, hypoglycaemia and intra cranial bleed
What is the treatment for hepatic encephalopathy?
Bowel clear out, lactulose and enemas
Antibiotics even if infection is not obvious
Supportive - airway support, IV, nasogastric tube
What is spontaneous bacterial peritonitis?
Infection of ascitic fluid in the abdomen. It is one of the most frequently encountered bacterial infections in patients with cirrhosis
What are the presentation of spontaneous bacterial peritonitis?
Abdominal pain, fever, rigors, renal impairment and signs of sepsis
What is the investigation of spontaneous bacterial peritonitis?
Ascitic tap - fluid protein, glucose levels, culture and WCC
Explain the results of spontaneous bacterial peritonitis on ascitic tap
Neutrophil count is more than 0.25x10^9/L
Protein is more than 25g/l
What is the treatment for spontaneous bacterial peritonitis?
IV antibiotics
Ascitic fluid drainage
IV albumin infusion
How does IV albumin infusion help spontaneous bacterial peritonitis?
Albumin increases vascular volume which reduces recurrence, improves kidney function and reduces septic process
What is the presentation of alcoholic hepatitis?
Jaundice
Encephalopathy
Infection
Decompensated hepatic function
What shows decompensated hepatic function?
Low albumin and raised prothrombin time/INR
What factors help diagnose alcoholic hepatitis?
Raised bilirubin
Raised GGT and AlkP
Alcoholic history
What is the prognosis of alcoholic hepatitis?
40% mortality
If severe then can be up to 90%
What is the treatment for alcoholic hepatitis?
Supportive
Treat the infection, encephalopathy and alcohol withdrawal
Protect against GI bleeding
Airway Protection/ ITU care
When are steroids given in alcoholic hepatitis?
Only if gradin shows severe
Glasgow Alcoholic hepatitis score of more than 9
Maddreys discriminant function more than 32
Describe the nutritional treatment of alcoholic hepatitis
frequent feeds and high energy requirement
Thiamine (Vitamin B)
What is the prognosis of alcoholic hepatitis?
Dependant on alcohol consumption
Steatohepatitis leads to cirrhosis
If decompensating liver - 70% mortality in 5 years
What is NAFLD and NASH?
Non alcoholic fatty liver disease
Non alcoholic steatohepatitis
What are some causes of a fatty liver?
Obesity
Diabetes
Hypercholesterolaemia
(alcohol)
How many cases of steatohepatitis causes cirrhosis?
1/4
How does non alcoholic steatohepatitis present?
Asymptomatic
Raised alanine amino transferase
Fatty liver on USS and liver biopsy
What is the treatment for steatohepatitis?
Weight loss and exercise
