Alcohol Related Liver Disease Flashcards
What affect does alcohol have on the Liver
Affect liver metabolism
Leading to toxicity
What is the breakdown of of alcohol is the liver
Ethanol is broken down by alcohol dehydrogenase to acetaldehyde and accetate
with the help of carrier molecule NAD+ –> NADH
What three metabolic pathways does alcohol affect
Gluogneogenesis
Lipogenesis
Citric acid cycle
What affect does alcohol have on gluocogeneiss
Prevents build up of glycogen reserve - can present hypoglycaemic
Build up of pyruvic acid - present acidosis
What affect does alcohol have on the lipogenesis
Interrupts lipid metabolism pathway
resulting in excess lipids
What two conditions result as a consequence of the alcohols affect on the liver
Steatoisis
Steatohepatits
How does steatosis occur in the liver
Alcohols interruption of lipid pathway metabolism results in fat being deposited in the liver
What is the pathology of steaohepatitis
Fat deposited in the liver triggers inflammation, as neutrophilial infiltration occurs
resulting in liver cell damage and death
This process of fibrosis occurs as scare tissue is deposited
This leads to `liver cirrhosis
What is the questions used in the CAGE questionnaire when taking a history of steaohepatitis
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 - need to drink in the morning?
What questioner is used to test the severity of alcohol usage
FAST/ AUDIT
When does the physical finding occur in alcohol damage to the liver
Advanced liver disease
What is the signs of chronic liver ddisease
Spider naevi palmar erythema, gynaecomastia (moobs) loss of axillary and pubic hair ascites, encephalopathy Jaundice Muscle wasting
What are the findings of Lab tests on chronic liver disease due to alcohol
Aspartate Amino Transferase (AAT) > alanine Amino Transferase (ALT). ratio
Raised Gamma Glutamyl Transferase
Macrocytosis - enlarged red blood cells
Thrombocytopenia (low platelets)
What is the AAT/alt ratio that indicated liver damage
> 2
What is the imaging diagnostic test for liver damage due to alcohol
Ultrasound - see if there is fat present on the liver
Define Hepatic encephalipathy
A feature of liver failure that goes on the affect brains toxicity due to high ammonia levels in the blood leading to the symptoms of confusion
What is the grading of Hepatic encephalipathy
Grade 1 - 4
- Mild confusion
- Coma
What can trigger Encephalopathy In liver disease
Infection drugs Constipation GI blled Electrolyte disturbance
What two things can also cause symptoms of Encephalopathy but aren’t related to liver disease
Hypoglyceamia
Intra cranial bled
An Infections out side the liver
- need to still be investigated
What is the affect of alcohol on the citric acid cycle
Prevents citric acid cycle occurring, producing excess acetyl coA which leads to ketosis
What is the treatment of Encephalopathy
Bowel clear out (if constipation related)
Antibiotics - if due to an infection
Support:
Airway support
Nasogastric tube
How does constipation with liver failure result in
Encephalopathy
In your faeces the urea is broken down to produce ammonia,
When you are constipated the ammonia is reabsorbed into the blood and the liver cant function properly
therefore remain in the blood and can travel to the brain and cause Encephalopathy
What is the presentation of a patient with spontaneous bacterial peritonitis
Abdominal pain Fevers/rigors Renal impairment Signs of sepsis (tachycardia, temperature)
When does spontaneous bacterial peritonitis usually happen
In patients with acites due to liver failure that leads to infection
What procedure is used for the diagnosis of spontaneous bacterial peritonitis
Ascitic tap
What does ascitic tap test for
Fluid protein and glucose levels - indicated kidney function
Cultures - find out the infection
White cell count - Is an infection present
What is an Ascitic tap
a needle is used to drain fluid that is trapped in an internal body cavity
What is the results of Ascitic tap in spontaneous bacterial peritonitis
Low protein levels of <25g/L
High neutrophil level of > 0.25x109 /L
What needs to be excluded in spontaneous bacteria peritonitis
Surgical cause of peritonitis
seen in high neutrophili level
What is the treatment of spontaneous bacteria peritonitis
IV antibiotics
ascitic fluid drainage
IV albumin infusion
What is the purpose of an IV albumin infusion
Improves kidney function
Preventing further leaking of fluid and draining acites
What is the clinical presentation of alcohol hepatitis
Jaundice
Encephalopathy
Infection usually present
Decomplensated hepatic function
What is an important sign of liver failure
Low albumin
Raised prothrombin =INR
If you have abnormal LFTS does this indicate you are in liver failure
if your albumin levels are fine you aren’t in liver failure
What are the biomarkers for alcohol hepatitis
raised GGT and Raised ALP (secreted by damaged liver cells)
What are the two other factors that are needed for the diagnosis of alcoholic hepatitis
Raised Bilirubin
Alcohol History
What is the prognosis of alcohol hepatitis
40% mortality
severe = 90% mortality
What further developments increase the mortality rate
decompensating liver disease signs - 70%
Encephalopathy - 64%
What does the prognosis depend highly upon
Abstinence or ongoing alcohol consumption
How many months does the guideline state abstinence to alcohol before liver transplant consideration
6 months
What is the management and treatment needed in alcohol hepatitis
Supportive
Airway Protection / ITU care
Treat infection
Treat encephalopathy
Treat alcohol withdrawal
Protect against GI bleeding
Nutrition
What is the drug treatment given if the grading of alcohol hepatitis is severe
Oral prednisolone 40mg Steroid
How is the treatment of nourishment given in alcohol hepatitis
Treat malnourishment
Feed frequently
High energy requirements
Give Thiamine - Vitamin B1
What is the benefit of nourishment treatment
Increases 2 year survival from 15% to 70%
What is the risk factors of fatty liver disease
Obesity
Diabetes
Hypercholestolaemia
{Alcohol}
Co-morbidity
Benign - alone fatWhat is the two types of fatty liver
Non alcoholic Steatosis (fatty liver)
Non alcoholic Steatohepatitis
fatty liver with inflammation
What is the pathology of fatty liver similar to
Similar to alcohol induced damage
What can fatty liver go on to develop
cirrhosis
What is the typical presentation of fatty liver
asymptomatic
What investigations are used for diagnosing fatty liver
Blood test - High ALT (show inflamed liver)
Ultrasound - see fat
Liver biopsy
What is the treatment of fatty liver disease
Weight loss
Exercise
