Alcohol related liver disease

Question 1

What is the problem with acetaldehyde in ethanol metabolism and what can it have an effect on?

Answer 1

toxic, carcinogen

other metabolic pathways

Question 2

What is steatosis?

Answer 2

fatty liver due to disrupted lipid metabolism

Question 3

What is steatohepatitis?

Answer 3

Fatty liver with inflammation

neutrophil infiltration, fibrosis and cirrhosis

Question 4

What is CAGE? what is it used for?

Answer 4

concern about your drinking
annoyed by criticism 
guilty about your drinking 
eye opener needed
assess dependency

Question 5

What other scores are used to measure dependency risk?

Answer 5

AUDIT/FAST

Question 6

What are the signs of chronic liver disease?

Answer 6

spider naevi, palmar erythema, gynaecomastia, loss of hair, ascites, encephalopathy, jaundice, muscle wasting

Question 7

What lab tests are used for alcoholic liver disease and the findings?

Answer 7

AAT>ALT
raised GGT
macrocytosis and thrombocytopenia

Question 8

What is macrocytosis?

Answer 8

large RBC

Question 9

What is thrombocytopenia?

Answer 9

low platelets

Question 10

How is alcohol related liver disease investigated?

Answer 10

USS and biopsies

Question 11

What is the scoring of encephalopathy and give an example of the scores

Answer 11

1 - mild confusion

4 -coma

Question 12

What are the causes of hepatic encephalopathy?

Answer 12

infection, GI bleed, constipation and drugs

Question 13

What do you have to eradicate with encephalopathy?

Answer 13

intra cranial bleed, infection and hypoglycaemia

Question 14

How is encephalopathy treated?

Answer 14

antibiotics, bowel clear out, supportive

Question 15

What are the symptoms of spontaneous bacterial peritonitis?

Answer 15

abdominal pain, fever, rigors, renal impairment and signs of sepsis

Question 16

What is the ascitic tap used for?

Answer 16

diagnose ascites

look for protein levels, glucose, white cell count and culture

Question 17

How is spontaneous bacterial peritonitis treated?

Answer 17

antibiotics, ascitic fluid drainage and IV albumin infusion

Question 18

Why is IV albumin infusion used to treat spontaneous bacterial peritonitis?

Answer 18

improve renal function

Question 19

How does alcoholic hepatitis present?

Answer 19

jaundice, encephalopathy, infection, decompensated liver function

Question 20

What are the blood test signs of decompensated liver function?

Answer 20

high prothrombin time

low albumin

Question 21

What is the diagnosis process for alcoholic hepatitis?

Answer 21

raised bilirubin, GGT, AlkP

scans and alcohol history

Question 22

Does alcoholic hepatitis have a good or poor prognosis?

Answer 22

poor

Question 23

How is alcoholic hepatitis treated?

Answer 23

antibiotics, treat withdrawl from alcohol and encephalopathy
protect against GI bleed
steroids if severe
nutrition - thiamine

Question 24

What can steatohepatitis lead to?

Answer 24

cirrhosis

Question 25

What are some causes of steatohepatitis?

Answer 25

diabetes, obesity, hypercholesterolaemia

Question 26

What are the investigations for steatohepatitis?

Answer 26

ultrasound
raised AAT
liver biopsy carries a risk

Question 27

How is steatohepatitis treated?

Answer 27

weight loss and exercise