Alcohol-related liver disease Flashcards
What is Alcohol-Related Liver Disease (ARLD)?
ARLD results from long-term excessive alcohol consumption, leading to liver damage. The severity of the disease varies between individuals, with genetic factors, obesity, and viral hepatitis increasing the risk.
What are the stages of alcohol-related liver disease?
- Alcoholic Fatty Liver (Hepatic Steatosis): Fat accumulation in the liver, reversible with abstinence.
- Alcoholic Hepatitis: Liver inflammation, reversible with abstinence in mild cases.
- Cirrhosis: Irreversible scarring of the liver tissue; stopping alcohol can prevent further damage.
What are the UK recommendations for alcohol consumption?
No more than 14 units per week, spread over 3 or more days, with no more than 5 units in a single day. Binge drinking is 6+ units for women and 8+ units for men in one session. Pregnant women should avoid alcohol completely.
What are the major complications of alcohol use?
- Alcohol-related liver disease
- Cirrhosis and its complications (e.g., hepatocellular carcinoma)
- Alcohol dependence and withdrawal
- Wernicke-Korsakoff syndrome (WKS)
- Pancreatitis
- Alcoholic cardiomyopathy
- Alcoholic myopathy
- Increased cardiovascular and cancer risk
What are the examination findings suggestive of excessive alcohol use?
- Smelling of alcohol
- Slurred speech
- Bloodshot eyes
- Dilated capillaries (telangiectasia) on the face
- Tremors
What blood test results suggest alcohol-related liver disease?
- Raised Mean Cell Volume (MCV)
- Raised Alanine Transaminase (ALT) and Aspartate Transaminase (AST)
- AST:ALT ratio >1.5 (suggestive of alcohol-related liver disease)
- Raised Gamma-Glutamyl Transferase (Gamma-GT)
- Raised Alkaline Phosphatase (ALP)
- Low albumin and increased prothrombin time in cirrhosis
- Deranged U&Es in hepatorenal syndrome
What imaging techniques can be used for alcohol-related liver disease?
- Liver ultrasound: Detects fatty changes and cirrhosis.
- Transient Elastography (FibroScan): Assesses liver stiffness (fibrosis).
- Endoscopy: Assesses oesophageal varices in portal hypertension.
- CT and MRI: Detects fatty liver, hepatocellular carcinoma, and ascites.
- Liver biopsy: Confirms diagnosis of alcohol-related hepatitis or cirrhosis.
What is the management approach for alcohol-related liver disease?
- Permanent alcohol abstinence
- Psychological interventions (e.g., motivational interviewing, CBT)
- Detoxification regimen
- Nutritional support (vitamins, high-protein diet)
- Corticosteroids for severe alcoholic hepatitis
- Treat cirrhosis complications (e.g., varices, ascites, hepatocellular carcinoma)
- Liver transplant (with 6 months of abstinence)
What defines alcohol dependence?
Daily alcohol consumption with strong urges, difficulty controlling intake, tolerance, and withdrawal symptoms upon cessation.
What are the CAGE questions for screening alcohol use?
- C: CUT DOWN? Do you think you should cut down on your drinking?
- A: ANNOYED? Do others get annoyed by your drinking?
- G: GUILTY? Do you feel guilty about your drinking?
- E: EYE OPENER? Do you drink in the morning to relieve hangovers or calm your nerves?
What is the AUDIT questionnaire used for?
The Alcohol Use Disorders Identification Test (AUDIT) screens for harmful alcohol use. A score of 8 or more indicates harmful alcohol consumption.
What are the stages of alcohol withdrawal symptoms?
- 6-12 hours: Tremor, sweating, headache, craving, anxiety
- 12-24 hours: Hallucinations
- 24-48 hours: Seizures
- 24-72 hours: Delirium Tremens (DT)
What are the symptoms of Delirium Tremens (DT) in alcohol withdrawal?
- Acute confusion
- Severe agitation
- Delusions and hallucinations
- Tremor
- Tachycardia
- Hypertension
- Hyperthermia
- Ataxia
- Arrhythmias
How is alcohol withdrawal managed?
- CIWA-Ar scale: Assesses withdrawal severity and guides treatment.
- Chlordiazepoxide: A benzodiazepine used to treat withdrawal symptoms.
- B vitamins (Pabrinex): To prevent Wernicke-Korsakoff syndrome.
What causes Wernicke-Korsakoff Syndrome (WKS)?
WKS is caused by thiamine (Vitamin B1) deficiency due to chronic alcohol use, leading to confusion, oculomotor disturbances, ataxia (Wernicke’s encephalopathy) and memory impairment, and behavioral changes (Korsakoff syndrome).
What are the features of Wernicke’s encephalopathy?
- Confusion
- Oculomotor disturbances (eye movement issues)
- Ataxia (lack of coordination)
What are the features of Korsakoff syndrome?
- Memory impairment (retrograde and anterograde)
- Behavioral changes
- Often irreversible, requiring long-term care
How can Wernicke-Korsakoff syndrome be prevented and treated?
- Thiamine supplementation (Vitamin B1)
- Alcohol abstinence
