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Alimentary System > Alcohol Related Liver Disease > Flashcards

Alcohol Related Liver Disease Flashcards

1
Q

What effect does alcohol have on the liver?

A

It is directly toxi

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2
Q

Why does alcohol affect us differently?

A

Depends on our genetics and how we metabolise alcohol

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3
Q

Who metabolises alcohol slower men or womeb?

A

Women

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4
Q

What is the toxic product of alcohol breakdown?

A

Acetaldehyde

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5
Q

What is acetaldehyde broken down to in the liver?

A

Acetate

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6
Q

What enzyme breaks ethanol down to acetaldehyde and acetate?

A

Alcohol dehydrogenase

Acetaldehyde dehydrogenase

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7
Q

Where is alcohol broken down?

A

In the liver

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8
Q

Which organ is vital for metabolism?

A

The liver

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9
Q

When the liver is metabolising alcohol what is interrupted?

A

Other metabolic pathways of the liver
E.g breakdown of fats
Or breakdown of glycogen to glucagon

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10
Q

What is steatosis?

A

Fatty liver

Can be either alcohol or non-alcohol related

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11
Q

What causes steatosis?

A

The presence of fat dumped in the liver

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12
Q

What is steatohepatitis?

A

Fatty liver with inflammation

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13
Q

What causes steatohepatitis?

A

The fat causes inflammation

Neutrophils infiltrate

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14
Q

Given an example of one unit of alchohol

A

Half pint of regular beer
1 small glass of wine
1 single measure of spirits
1 small glass of sherry

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15
Q

What are the clinical signs of steatosis and steatohepatitis?

A

Majority will show no physical findings until they present with advanced liver disease

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16
Q

What are the signs of chronic liver disease?

A 
Spider naevi 
Palmar erythema 
Gynaecomastia 
Loss of axillary and pubic hair 
Ascites 
Encephalopathy (confusion)
Jaundice 
Muscle wasting 
Hepatomegaly
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17
Q

What labs are suggestive of chronic liver disese?

A 
AAT>ALT 
Raised GGT 
Macrocytosis (enlarged RBC)
Thrombocytopenia (low platelets) 
Increase bilirubin 
USS fatty liver
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18
Q

What is raised GGT a sign of?

A

Excessive alcohol consupmtion

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19
Q

What is hepatic encephalopathy?

A

Confusion and issues caused by high ammonia levels in the system

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20
Q

How is hepatic encephalopathy graded?

A

Grade 1 - 4

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21
Q

What is grade 1 in hepatic encephalopathy?

A

Mild confusion

22
Q

What is grade 4 hepatic encephalopathy?

A

Coma

23
Q

What are the causes of hepatic encephalopathy?

A 
Infection 
Drugs 
Constipation 
GI bleed
Electrolyte disturbance
24
Q

How does constipation cause hepatic encephalopathy?

A

A lot of ammonia gets passed out in faeces
So if constipated a lot gets backed up
A lot of ammonia is reabsorbed into the system
Travelling up to the brain

25
Q

What is the treatment for hepatic encephalopathy?

A

Bowel clear out
Antibiotics
Supportive - ITU, Airway control, NG tube

26
Q

What is spontaneous bacterial peritonitis?

A

Spontaneous infection in the peritoneal cavity

27
Q

What are the symptoms of spontaneous bacterial peritonitis?

A 
Abdominal Pain 
Fever 
-	Due to infection 
Rigors 
Renal impairment 
Signs of sepsis 
Tachycardia 
Ascites
28
Q

What is ascitic tapping?

A

Removing small amounts of the ascitic fluid from the abdomen

29
Q

What is measured in an ascitic tap?

A

WCC
Protein and glucose levels
Culture

30
Q

Why is a culture done in an ascitic tap?

A

To test for any pathogens

31
Q

What is the treatment for spontaneous bacterial peritonitis?

A

IV antibiotic
Ascitic fluid drainage
IV albumin infusion

32
Q

What is the presentation of alcoholic hepatitis?

A 
Jaundice 
Encephalopathy 
Infection is common 
Decompensated hepatic function 
Low albumin
Raised prothrombin time
33
Q

What are the diagnostic markers for alcoholic hepatitis?

A

Raised bilirubin
Raised GGT and AlkP
Alcohol History

34
Q

What is the treatment for alcoholic hepatitis?

A 
Supportive care 
Treat infection 
Treat encephalopathy 
Treat alcohol withdrawal 
-	Fluid 
-	diazepam
Protect against GI bleeding 
Airway protection 
ITU
35
Q

Which score gives you a high mortality risk in alcoholic hepatitis?

A

> 9

36
Q

If alcoholic hepatitis grading is severe what should it be treated with?

A

Steroids

37
Q

What is the prognosis in alcoholic hepatitis dependant on?

A

If the patient is willing to give up alcohol or not

38
Q

What do you need to do to qualify for liver Tx?

A

Give up alcohol

39
Q

What is NAFLD and NASH related to?

A 
DM 
Obesity 
Hypertriglyceridemia 
Hypertension 
Hypertlipidaemia
40
Q

What causes NASH?

A

Fat deposition leading to inflammation

41
Q

What can be some signs of NASH?

A

Raised AAT
Fatty liver on USS
Liver biopsy -> histology show white fatty deposits

42
Q

What is the treatment for NASH?

A

Weight loss
Exercise
Trying to reverse the cause

43
Q

What is NAFLD?

A

Spectrum of diseases from steatosis-steatohepatitis - Fibrosis- cirrhosis

44
Q

What are symptoms of NAFLD that has severely progressed?

A

Pain right upper quadrant
Jaundice
Hepatomegaly
Ascites

45
Q

What is alcohol induced steatosis?

A

Fatty liver due to alcohol

46
Q

What can alcohol induced steatosis lead to?

A

Alcoholic hepatitis

47
Q

Which is more raised in alcohol liver disease AST or ALT?

A

AST

48
Q

Treatment for alcohol liver disease?

A

Stop alcohol consumption

49
Q

What is raised GTT LFT a sign of

A

Alcohol related

50
Q

When is alcoholic hepatitis treated with oral corticosteroids?

A

When maddrey’s discriminant >32

51
Q

Which score is used to stage alcoholic hepatitis?

A

Glasgow Alcoholic Hepatitis Score

Alimentary System (29 decks)

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