Alcohol related liver disease Flashcards
What is the problem with acetaldehyde in ethanol metabolism and what can it have an effect on?
toxic, carcinogen
other metabolic pathways
What is steatosis?
fatty liver due to disrupted lipid metabolism
What is steatohepatitis?
Fatty liver with inflammation
neutrophil infiltration, fibrosis and cirrhosis
What is CAGE? what is it used for?
concern about your drinking annoyed by criticism guilty about your drinking eye opener needed assess dependency
What other scores are used to measure dependency risk?
AUDIT/FAST
What are the signs of chronic liver disease?
spider naevi, palmar erythema, gynaecomastia, loss of hair, ascites, encephalopathy, jaundice, muscle wasting
What lab tests are used for alcoholic liver disease and the findings?
AAT>ALT
raised GGT
macrocytosis and thrombocytopenia
What is macrocytosis?
large RBC
What is thrombocytopenia?
low platelets
How is alcohol related liver disease investigated?
USS and biopsies
What is the scoring of encephalopathy and give an example of the scores
1 - mild confusion
4 -coma
What are the causes of hepatic encephalopathy?
infection, GI bleed, constipation and drugs
What do you have to eradicate with encephalopathy?
intra cranial bleed, infection and hypoglycaemia
How is encephalopathy treated?
antibiotics, bowel clear out, supportive
What are the symptoms of spontaneous bacterial peritonitis?
abdominal pain, fever, rigors, renal impairment and signs of sepsis
What is the ascitic tap used for?
diagnose ascites
look for protein levels, glucose, white cell count and culture
How is spontaneous bacterial peritonitis treated?
antibiotics, ascitic fluid drainage and IV albumin infusion
Why is IV albumin infusion used to treat spontaneous bacterial peritonitis?
improve renal function
How does alcoholic hepatitis present?
jaundice, encephalopathy, infection, decompensated liver function
What are the blood test signs of decompensated liver function?
high prothrombin time
low albumin
What is the diagnosis process for alcoholic hepatitis?
raised bilirubin, GGT, AlkP
scans and alcohol history
Does alcoholic hepatitis have a good or poor prognosis?
poor
How is alcoholic hepatitis treated?
antibiotics, treat withdrawl from alcohol and encephalopathy
protect against GI bleed
steroids if severe
nutrition - thiamine
What can steatohepatitis lead to?
cirrhosis
What are some causes of steatohepatitis?
diabetes, obesity, hypercholesterolaemia
What are the investigations for steatohepatitis?
ultrasound
raised AAT
liver biopsy carries a risk
How is steatohepatitis treated?
weight loss and exercise
