Alcohol Related Liver Disease Flashcards
What is ethanol converted to
Acetaldehyde (toxic)
What is acetaldehyde converted to
Acetate
What does toxicity depend on
Bodys ability to convert acetaldehyde to acetate
How does the metabolism of ethanol disrupt pathways
Produces excess NADH which causes:
- increased lipogenesis
- pyruvic acid build up which converts to lactic acid causing acidosis
- hypoglycaemia by disrupting gluconeogenesis (prevent glycogen build up)
Where is fat deposited
Because of ethanols disruption to lipid metabolism fat is deposited in the liver:
- steatosis (fatty liver)
- steatohepatitis (FL+inflammation)
What should you ask about alcohol (CAGE)
Felt need to CUT down
Been ANNOYED by criticism of drinking
Felt GUILTY about drinking
Need EYEOPENER (drink in morning)
Physical Findings
Signs of chronic liver disease:
- spider naevi
- palmar erythema
- gynaecomastia
- jaundice
- ascites
- encephalopathy
- muscle wasting
- loss of axillary / pubic hair
Lab testing
AST > ALT
Gamma GT (elevated)
Macrocytosis (enlarged RBCs)
Thrombocytopenia (low platelets)
Investigation for fatty liver
USS
Causes fatty liver
Obesity
Diabetes
Hypercholesterolaemia
Alcohol
Presentation of steatohepatits
Asymptomatic
Raised ALT
Fatty liver on USS
Treatment of steatohepatitis
Weight
Exercise
No drug therapy
What can steatohepatitis lead to
cirrhosis
