Alcohol Related Liver Disease Flashcards
What percentage of heavy drinkers will at some point develop serious liver disease?
20
Which sex is more susceptible at lower volumes of alcohol?
Women
What is the name of the questions asked to ascertain alcohol dependency?
CAGE questions
What are the CAGE questions?
-ever thought of Cutting down on your consumption?
-has anyone ever Annoyed you by criticising your consumption?
-ever felt Guilty or bad about the amount you drink?
-ever had an eye opener to steady nerves in the morning
(+drinking to relieve withdrawal symptoms)
How many CAGE questions need to be met to be telling of alcoholism?
2 or more
What other factors may increase the chance of developing liver disease?
Hep C, obesity, drug use
What is the first stage of disease due to alcohol?
Fatty liver disease
What converts alcohol to acetaldehyde?
Alcohol dehydrogenase
What converts acetaldehyde to acetate?
Aldehyde dehydrogenase
What is the name of the alternate system?
Microsomal alcohol oxidising system
What is the calorie content of alcohol (kcal/g)
8 kcal/g
What is acetate converted in to?
Fatty acids
Where are these fatty acids deposited?
Zone 3 of the liver (round the central veins)
What is this fat deposition process known as?
Steatosis
What happens if alcohol consumption ceases?
Steatosis is reversed
If alcohol consumption continues despite Steatosis what happens?
Inflammation and fat deposition lead to steatohepatitis
What are the signs of steatohepatitis?
Malaise, anorexia, diarrhoea, vomiting, tender hepatomegaly, jaundice, bleeding and ascites
What will the blood tests show for alcoholic hepatitis?
Raised WCC, reduced platelet count, raised INR, raised AST, raised MCV raised urea
What three symptoms show severe hepatitis?
Jaundice, coagulapathy, encephalopathy
What is the management for alcoholic hepatitis?
Admit, CVP and urinary catheter, screen for infections, stop alcohol consumption, give vitamin K and thiamine, optimise nutrition, prendisalone
What would you give for those being withdrawn from alcohol?
Chlorodiazypoxide PO
Or if unable give IM lorazepam
What is the 30 day mortality for severe alcoholic hepatitis?
50%
Within a year how many of those admitted for alcoholic hepatitis of any grade die?
40%
What might alcoholic hepatitis or Steatosis develop to?
Fibrosis/cirrhosis
Alcoholic cirrhosis is usually micro or macro nodular?
Micro, may become macro if alcohol is stopped
How many units of alcohol must be consumed to be classed as a heavy drinker?
100
