Alcohol Related Liver Disease

Question 1

in the oxidative metabolism of alcohol, what is ethanol first converted to and by what enzyme?

Answer 1

ethanol - acetaldehyde

by alcohol dehydrogenase

Question 2

in the oxidative metabolism of ethanol, what is acetaldehyde converted to and by what enzyme?

Answer 2

acetaldehyde - acetate

by acetaldehyde dehydrogenase

Question 3

in oxidative metabolism, what drives the enzymatic reaction?

Answer 3

NAD –> NADH

Question 4

what are some of the signs of chronic liver disease?

Answer 4

jaundice
spider naevi
loss of body hair
clubbing, dupuyrens contractures, palmar erythema, xanthomas
gynaecomasta
loss of muscle mass
hepatomegaly, splenomegaly, ascites, scratch marks

Question 5

what is fatty liver disease and how is it caused?

Answer 5

when alcohol is metabolised it produces fat in the liver
with larger amounts of alcohol consumed the cells become swollen with fat = steatosis
but there is no cell damage
NAFLD caused by excess fat in the liver

Question 6

what are the risk factors for non alcohol related steatosis (NAFLD)?

Answer 6

obesity
diabetes
hypercholesterolaemia
alcohol (could be a co-morbidity)

Question 7

what are the clinical features of fatty liver disease?

Answer 7

often no symptoms or signs

may have nausea, vomiting and diarrhoea which are general effects of alcohol on the GI tract.

• Maybe symptoms of chronic liver failure

Question 8

what investigations can be carried out in diagnosing fatty liver disease?

Answer 8

increase in MVC
Increase in AAT & ALT
gamma - GT level

USS and CT
Elastography

Question 9

why may elastography be used in investigating fatty liver disease?

Answer 9

to investigate the extent of the fibrosis

Question 10

in fatty liver disease, why is gamma - GT carried out?

Answer 10

determines if they are still drinking alcohol

Question 11

what is the outcome for fatty liver disease?

Answer 11

with stopping smoking the fat in the liver will disappear and the liver biochem will return to normal
if drinking persists then it may develop into alcoholic hepatitis and cirrhosis

Question 12

what is steatohepatitis?

Answer 12

fatty liver disease plus inflammation

Question 13

what is the pathology of steatohepatitis?

Answer 13

fatty liver disease plus inflammation
neutrophil infiltration
fibrosis , cirrhosis = build up of scar tissue

Question 14

what investigation can be carried out to confirm diagnose steatohepatitis?

Answer 14

liver biopsy - gold standard

• ALT/AST ratio
• USS
• CT/MRI
• MR spectroscopy
• Enhanced liver fibrosis panel
• cytokeratin -18
• fibroscan

Question 15

what is the treatment for non alcohol steatohepatitis?

Answer 15

weight loss
exercise
weight loss surgery
vitamin E
insulin sensitisers i.e. metformin
glucagon like peptide 1 i.e. liraglutide
farnesoid x nuclear receptor ligand e.g. obeticholic acid

Question 16

what is the presentation for alcoholic hepatitis?

Answer 16

jaundice
encephalopathy
infection is common
decompensated live function - low albumin and raised prothrombin time/INR

Question 17

what tests are carried out for the diagnosis of alcoholic hepatitis?

Answer 17

raised billirubin

raised gamma-GT and Alk phosphate level

Question 18

what treatment is given for alcoholic hepatitis?

Answer 18

supportive treatment i.e. stop drinking, treat infection, treat encephalopathy, treat alcohol withdrawal, protect against GI bleed, airway protect if needed
steroids
thiamine and nutrition

Question 19

what is hepatic encepahlopathy?

Answer 19

hepatic encephalopathy is a spectrum of brain injury commonly found in patients with liver cirrhosis

Question 20

what can encephalopathy cause in patients with liver cirrhosis?

Answer 20

infection
GI bleed
constipation
GI bleed
electrolyte imbalance

Question 21

what is the treatment for hepatic encephalopathy?

Answer 21

bowel clear out
antibiotics
supportive i.e. ITU airway support and NG tube for meds

Question 22

what is spontaneous bacterial peritonitis?

Answer 22

infection of ascitic fluid with no apparent source

commonly found in people with liver cirrhosis

Question 23

what are the symptoms of bacterial peritonitis?

Answer 23

abdominal pain
fever, rigors
renal impairment
signs of seeps i.e. tachycardia and fever

Question 24

what are the signs of bacterial peritonitis?

Answer 24

neutrophil could > o.25x10(9)

protein <25g/l

Question 25

what investigations are carried out to diagnose bacterial peritonitis?

Answer 25

ascitic tap –

• fluid protein and glucose
• white cell count
• cultures

Question 26

what is the treatment for bacterial peritonitis?

Answer 26

anti biotics
ascitic fluid drainage
IV albumin infusion (for low protein levels)

Question 27

what is the main presentation of encephalopathy?

Answer 27

mild confusion to coma

Question 28

in the treatment of alcohol hepatitis, when is steroids given as treatment?

Answer 28

if their glasgow alcohol hepatitis score >9

madders discriminant function >32

Question 29

why is thiamine given as a treatment for alcohol hepatitis?

Answer 29

70% of patients present malnourished , thiamine (Vitamin B) is given as well as high energy nutrition

Question 30

how do you investigate wether a patients encephalopathy is due to liver disease or something else?

Answer 30

do an ammonia level test
it will be elevated in someone with liver disease because the lockage of functioning hepatic cells results in the liver not able to fight toxins
this causes a build up of ammonia

Question 31

what metabolic syndromes/conditions put people at risk for developing non-alcoholic fatty liver disease?

Answer 31

diabetes mellitus
hypertension
hypertriglyceride
obesity

Question 32

what percentage of people with NASH develop cirrhosis?

Answer 32

15%