Alcohol Related Liver Disease Flashcards
What effect does alcohol have on the liver?
It is directly toxi
Why does alcohol affect us differently?
Depends on our genetics and how we metabolise alcohol
Who metabolises alcohol slower men or womeb?
Women
What is the toxic product of alcohol breakdown?
Acetaldehyde
What is acetaldehyde broken down to in the liver?
Acetate
What enzyme breaks ethanol down to acetaldehyde and acetate?
Alcohol dehydrogenase
Acetaldehyde dehydrogenase
Where is alcohol broken down?
In the liver
Which organ is vital for metabolism?
The liver
When the liver is metabolising alcohol what is interrupted?
Other metabolic pathways of the liver
E.g breakdown of fats
Or breakdown of glycogen to glucagon
What is steatosis?
Fatty liver
Can be either alcohol or non-alcohol related
What causes steatosis?
The presence of fat dumped in the liver
What is steatohepatitis?
Fatty liver with inflammation
What causes steatohepatitis?
The fat causes inflammation
Neutrophils infiltrate
Given an example of one unit of alchohol
Half pint of regular beer
1 small glass of wine
1 single measure of spirits
1 small glass of sherry
What are the clinical signs of steatosis and steatohepatitis?
Majority will show no physical findings until they present with advanced liver disease
What are the signs of chronic liver disease?
Spider naevi Palmar erythema Gynaecomastia Loss of axillary and pubic hair Ascites Encephalopathy (confusion) Jaundice Muscle wasting Hepatomegaly
What labs are suggestive of chronic liver disese?
AAT>ALT Raised GGT Macrocytosis (enlarged RBC) Thrombocytopenia (low platelets) Increase bilirubin USS fatty liver
What is raised GGT a sign of?
Excessive alcohol consupmtion
What is hepatic encephalopathy?
Confusion and issues caused by high ammonia levels in the system
How is hepatic encephalopathy graded?
Grade 1 - 4
What is grade 1 in hepatic encephalopathy?
Mild confusion
What is grade 4 hepatic encephalopathy?
Coma
What are the causes of hepatic encephalopathy?
Infection Drugs Constipation GI bleed Electrolyte disturbance
How does constipation cause hepatic encephalopathy?
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
What is the treatment for hepatic encephalopathy?
Bowel clear out
Antibiotics
Supportive - ITU, Airway control, NG tube
What is spontaneous bacterial peritonitis?
Spontaneous infection in the peritoneal cavity
What are the symptoms of spontaneous bacterial peritonitis?
Abdominal Pain Fever - Due to infection Rigors Renal impairment Signs of sepsis Tachycardia Ascites
What is ascitic tapping?
Removing small amounts of the ascitic fluid from the abdomen
What is measured in an ascitic tap?
WCC
Protein and glucose levels
Culture
Why is a culture done in an ascitic tap?
To test for any pathogens
What is the treatment for spontaneous bacterial peritonitis?
IV antibiotic
Ascitic fluid drainage
IV albumin infusion
What is the presentation of alcoholic hepatitis?
Jaundice Encephalopathy Infection is common Decompensated hepatic function Low albumin Raised prothrombin time
What are the diagnostic markers for alcoholic hepatitis?
Raised bilirubin
Raised GGT and AlkP
Alcohol History
What is the treatment for alcoholic hepatitis?
Supportive care Treat infection Treat encephalopathy Treat alcohol withdrawal - Fluid - diazepam Protect against GI bleeding Airway protection ITU
Which score gives you a high mortality risk in alcoholic hepatitis?
> 9
If alcoholic hepatitis grading is severe what should it be treated with?
Steroids
What is the prognosis in alcoholic hepatitis dependant on?
If the patient is willing to give up alcohol or not
What do you need to do to qualify for liver Tx?
Give up alcohol
What is NAFLD and NASH related to?
DM Obesity Hypertriglyceridemia Hypertension Hypertlipidaemia
What causes NASH?
Fat deposition leading to inflammation
What can be some signs of NASH?
Raised AAT
Fatty liver on USS
Liver biopsy -> histology show white fatty deposits
What is the treatment for NASH?
Weight loss
Exercise
Trying to reverse the cause
What is NAFLD?
Spectrum of diseases from steatosis-steatohepatitis - Fibrosis- cirrhosis
What are symptoms of NAFLD that has severely progressed?
Pain right upper quadrant
Jaundice
Hepatomegaly
Ascites
What is alcohol induced steatosis?
Fatty liver due to alcohol
What can alcohol induced steatosis lead to?
Alcoholic hepatitis
Which is more raised in alcohol liver disease AST or ALT?
AST
Treatment for alcohol liver disease?
Stop alcohol consumption
What is raised GTT LFT a sign of
Alcohol related
When is alcoholic hepatitis treated with oral corticosteroids?
When maddrey’s discriminant >32
Which score is used to stage alcoholic hepatitis?
Glasgow Alcoholic Hepatitis Score
