Alcohol Related Liver Disease

Question 1

What percentage of heavy drinkers will at some point develop serious liver disease?

Answer 1

20

Question 2

Which sex is more susceptible at lower volumes of alcohol?

Answer 2

Women

Question 3

What is the name of the questions asked to ascertain alcohol dependency?

Answer 3

CAGE questions

Question 4

What are the CAGE questions?

Answer 4

-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)

Question 5

How many CAGE questions need to be met to be telling of alcoholism?

Answer 5

2 or more

Question 6

What other factors may increase the chance of developing liver disease?

Answer 6

Hep C, obesity, drug use

Question 7

What is the first stage of disease due to alcohol?

Answer 7

Fatty liver disease

Question 8

What converts alcohol to acetaldehyde?

Answer 8

Alcohol dehydrogenase

Question 9

What converts acetaldehyde to acetate?

Answer 9

Aldehyde dehydrogenase

Question 10

What is the name of the alternate system?

Answer 10

Microsomal alcohol oxidising system

Question 11

What is the calorie content of alcohol (kcal/g)

Answer 11

8 kcal/g

Question 12

What is acetate converted in to?

Answer 12

Fatty acids

Question 13

Where are these fatty acids deposited?

Answer 13

Zone 3 of the liver (round the central veins)

Question 14

What is this fat deposition process known as?

Answer 14

Steatosis

Question 15

What happens if alcohol consumption ceases?

Answer 15

Steatosis is reversed

Question 16

If alcohol consumption continues despite Steatosis what happens?

Answer 16

Inflammation and fat deposition lead to steatohepatitis

Question 17

What are the signs of steatohepatitis?

Answer 17

Malaise, anorexia, diarrhoea, vomiting, tender hepatomegaly, jaundice, bleeding and ascites

Question 18

What will the blood tests show for alcoholic hepatitis?

Answer 18

Raised WCC, reduced platelet count, raised INR, raised AST, raised MCV raised urea

Question 19

What three symptoms show severe hepatitis?

Answer 19

Jaundice, coagulapathy, encephalopathy

Question 20

What is the management for alcoholic hepatitis?

Answer 20

Admit, CVP and urinary catheter, screen for infections, stop alcohol consumption, give vitamin K and thiamine, optimise nutrition, prendisalone

Question 21

What would you give for those being withdrawn from alcohol?

Answer 21

Chlorodiazypoxide PO

Or if unable give IM lorazepam

Question 22

What is the 30 day mortality for severe alcoholic hepatitis?

Answer 22

50%

Question 23

Within a year how many of those admitted for alcoholic hepatitis of any grade die?

Answer 23

40%

Question 24

What might alcoholic hepatitis or Steatosis develop to?

Answer 24

Fibrosis/cirrhosis

Question 25

Alcoholic cirrhosis is usually micro or macro nodular?

Answer 25

Micro, may become macro if alcohol is stopped

Question 26

How many units of alcohol must be consumed to be classed as a heavy drinker?

Answer 26

100