Alcohol Related Liver Disease Flashcards
what is ethanol broken down into
acetaldehyde
what is acetaldehyde
a toxic metabolite, toxic and carcinogenic
side effects include - flushing and nausea
what is acetaldehyde broken down into
acetate
what other metabolic pathways are affected by ethanol excess
excess lipids, lactic acid, ketones = acidosis
breakdown in gluconeogenesis and glycolysis pathway, glycogen not metabolised = hyperglycemia
what effect does alcohol have on the appearance of the liver
steatosis
steatohepatitis
steatosis
fatty liver
steatohepatitis
fatty liver with inflammation
Neutrophil infiltration
Fibrosis, Cirrhosis (Build up of scar tissue)
what questions must you ask the patient in relation to alcohol consumption
Have you ever felt the need to Cut down
Have you been Annoyed by criticism of your drinking?
Have you felt Guilty about your drinking
Do you need an Eyeopener
what is the scoring system used to assess alcohol intake
FAST
what questions are rated 1-4 in FAST
How often have you had 6 or more units if female, or 8 or more if male, on a single occasion in the last year?
Only answer the following questions if the answer above is Never (0), Less than monthly (1) or Monthly (2). Stop here if the answer is Weekly (3) or Daily (4).
How often during the last year have you failed to do what was normally expected from you because of your drinking?
How often during the last year have you been unable to remember what happened the night before because you had been drinking?
Has a relative or friend, doctor or other health worker been concerned about your drinking or suggested that you cut down?
how is the FAST scoring system scored
If score is 0, 1 or 2 on the first question
continue with the next three questions
If score is 3 or 4 on the first question – stop here.
An overall total score of 3 or more is FAST positive.
what do you do if a patient is fast positive
What to do next?
If FAST positive, complete remaining AUDIT questions (this may include the three remaining questions above as well as the six questions on the second page) to obtain a full AUDIT score.
what are the physical findings of someone with alcohol related liver disease
Majority no physical findings until advanced liver disease
Signs of chronic liver disease
Spider naevi, palmar erythema, gynaecomastia, loss of axillary and pubic hair, ascites, encephalopathy
Jaundice
Muscle wasting
what lab results are found in a patient with alcohol related liver disease
Aspartate Amino Transferase (AAT) > alanine
Amino Transferase (ALT). Ratio >2
Raised Gamma Glutamyl Transferase
Macrocytosis
Thrombocytopenia (low platelets)
what test is run for fatty liver
USS
what is a feature of liver feature that is graded 1-4
hepatic encephalopathy
1- mild confusion
4- coma
what are the causes of hepatic encephalopathy
Infection
Drugs
Constipation [bowel not cleareing build up of metabolites (ammonia), can cross bowel wall and go into bloood brain barrier causing confusion]
GI Bleed
Electrolyte Disturbance
what alternative diagnosis must be exluded before diagnosing hepatic encephalopathy
Infection
Hypoglycaemia
Intra Cranial Bleed
what is treatment for hepatic encephalopathy
Treatment
Bowel clear out, lactulose, enemas.
Antibiotics
Supportive
ITU, airway support
Nasogastric tube for meds
what are the signs of Spontaneous Bacterial Peritonitis
Abdominal Pain
Fever, Rigors
Renal impairment
Signs of Sepsis, tachycardia, temperature
what is the diagnostic process for Spontaneous Bacterial Peritonitis
Ascitic Tap
Fluid Protein and Glucose levels
Cultures
White Cell Content
what should the ascitic tap show for Spontaneous Bacterial Peritonitis
Neutrophil Count >0.25x109 /L
Protein <25g/L
what alternative diagnosis must be excluded before diagnosis Spontaneous Bacterial Peritonitis
Exclude surgical causes of peritonitis
what is treatment for Spontaneous Bacterial Peritonitis
IV Antibiotics
Ascitic Fluid Drainage
IV Albumin Infusion (20% ALBA)
