Alcohol Related Liver Disease

Question 1

What are the stages of ARLD

Answer 1

1) Steatosis - fat build up in liver
2)Acute & Chronic Alcoholic Hepatitis
3)Fibrosis - scarring in the liver (reversible)
4)Cirrhosis - long-term damage caused by severe and extensive patterns of scarring (leads to liver failure)

Question 2

Steatosis

Answer 2

~Occurs in 90% of patients who drink >7 units/day
~heals by reduction of alcohol

Question 3

Hepatitis fatty acids

Answer 3

~imbalance occurs between FAs from diet, adipose tissue lipolysis, creation of new lipids & removal of FAs
~Accumulation of lipids > steatosis
~Alcohol dehydrogenase overwhelmed - the MEOS & catalase increase production of toxic byproducts - inflammation
~Change in intestinal permeability - toxic affect on mucosa(leaky gut), altered abundance of microbiota, infection, inflammation, & gut-brain axis impaired

Question 4

Risk factors of ARLD

Answer 4

Binge drinking, obesity, genetics, African & Hispanic ethnicity, female sex

Question 5

Signs & symptoms of ARLD

Answer 5

~abdominal pain
~dry mouth
~vascular change & anaemia - reduced transferrin causes hypochromic anaemia
~Bruising - lack of thrombopoietin, vitamin K, clotting factors - thrombocytopenia
~jaundice - decrease in bilirubin removal
~impaired glucose - numbness
~hepatic encephalopathy

Question 6

Jaundice & Hyperbilrubinaemia

Answer 6

~jaundice = increased bilirubin in blood & urine
~Senescent RBCs - phagocytosed by macrophage in splenic & hepatic sinusoids - haem> biliverdin(haem oxygenase) > bilirubin(bilirubin reductase)
~Bilirubin + guluronic acid - soluble in water - excreted as urobilin(urine) & stercobilin (faeces)

Question 7

ARLD Diagnosis: Biochemistry

Answer 7

~liver panel & liver function test
~liver enzyme test, ALP,AST,ALT,&GGT - AST:ALT > 1(ALT increase) - GGT increase
~Increace bilirubin
~Decrease albumin

Question 8

ARLD Diagnosis: Haematology

Answer 8

~Decrease platelet count (decrease thrombopoietin)
~Prothrombin time (extrinsic & common coagulation factor) & Activated partial thromboplastin time (intrinsic & common coagulation factor)
~Serum ferritin (1° tissue iron storage protein)

Question 9

ARLD Diagnosis: Histology

Answer 9

Biopsy - steatosis (fat deposits -‘clear’ patch), fibrosis (collagen deposits -‘dark’ streak), cirrhosis (collagen deposits & change to vasculature), hepatocellular carcinoma (increased hepatocytes)

Question 10

Complications: Portal Hypertension

Answer 10

~High blood pressure in the portal vein(nutrient & toxin rich blood from GI tract, gallbladder, pancreas, spleen to liver
~Cirrhosis & scarring - narrow walls and greater resistance

Question 11

Complications: Ascites

Answer 11

~Fluid in peritoneal cavity
~Caused by hypertension, vasodilation and reduced plasma proteins - reduced oncotic pressure
~Abdominal swelling & discomfort, weight gain, early satiety, shortness of breath
~spontaneous bacterial peritonitis & haernias
~Treated by reducing alcohol, salt, & fluids, diuretics, & fluid drains
~Diagnoses by paracentesis(drain fluid via needle), micro samples, histology, CT & MRI scan

Question 12

Complications: Hepatocellular Carcinoma

Answer 12

~Classified using Barcelona staging
~32-45% of HCC from ARLD
~Treatment: surgical excision (≤2/3), transplantation (cancers reaches distal site), chemotherapy (cancer metastasised)
~Prognosis (5 year survival) 18.4%, 33% (early), & 3% (distal site) - aggressive (high doubling time of hepatocytes
~Abnormal LFT & clotting times, histology, & elevates alpha fetoprotein (tumours)