Alcohol Related Liver Disease Flashcards
in the oxidative metabolism of alcohol, what is ethanol first converted to and by what enzyme?
ethanol - acetaldehyde
by alcohol dehydrogenase
in the oxidative metabolism of ethanol, what is acetaldehyde converted to and by what enzyme?
acetaldehyde - acetate
by acetaldehyde dehydrogenase
in oxidative metabolism, what drives the enzymatic reaction?
NAD –> NADH
what are some of the signs of chronic liver disease?
jaundice
spider naevi
loss of body hair
clubbing, dupuyrens contractures, palmar erythema, xanthomas
gynaecomasta
loss of muscle mass
hepatomegaly, splenomegaly, ascites, scratch marks
what is fatty liver disease and how is it caused?
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
what are the risk factors for non alcohol related steatosis (NAFLD)?
obesity
diabetes
hypercholesterolaemia
alcohol (could be a co-morbidity)
what are the clinical features of fatty liver disease?
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
what investigations can be carried out in diagnosing fatty liver disease?
increase in MVC
Increase in AAT & ALT
gamma - GT level
USS and CT
Elastography
why may elastography be used in investigating fatty liver disease?
to investigate the extent of the fibrosis
in fatty liver disease, why is gamma - GT carried out?
determines if they are still drinking alcohol
what is the outcome for fatty liver disease?
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
what is steatohepatitis?
fatty liver disease plus inflammation
what is the pathology of steatohepatitis?
fatty liver disease plus inflammation
neutrophil infiltration
fibrosis , cirrhosis = build up of scar tissue
what investigation can be carried out to confirm diagnose steatohepatitis?
liver biopsy - gold standard
- ALT/AST ratio
- USS
- CT/MRI
- MR spectroscopy
- Enhanced liver fibrosis panel
- cytokeratin -18
- fibroscan
what is the treatment for non alcohol steatohepatitis?
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
what is the presentation for alcoholic hepatitis?
jaundice
encephalopathy
infection is common
decompensated live function - low albumin and raised prothrombin time/INR
what tests are carried out for the diagnosis of alcoholic hepatitis?
raised billirubin
raised gamma-GT and Alk phosphate level
what treatment is given for alcoholic hepatitis?
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
what is hepatic encepahlopathy?
hepatic encephalopathy is a spectrum of brain injury commonly found in patients with liver cirrhosis
what can encephalopathy cause in patients with liver cirrhosis?
infection GI bleed constipation GI bleed electrolyte imbalance
what is the treatment for hepatic encephalopathy?
bowel clear out
antibiotics
supportive i.e. ITU airway support and NG tube for meds
what is spontaneous bacterial peritonitis?
infection of ascitic fluid with no apparent source
commonly found in people with liver cirrhosis
what are the symptoms of bacterial peritonitis?
abdominal pain
fever, rigors
renal impairment
signs of seeps i.e. tachycardia and fever
what are the signs of bacterial peritonitis?
neutrophil could > o.25x10(9)
protein <25g/l
what investigations are carried out to diagnose bacterial peritonitis?
ascitic tap –
- fluid protein and glucose
- white cell count
- cultures
what is the treatment for bacterial peritonitis?
anti biotics
ascitic fluid drainage
IV albumin infusion (for low protein levels)
what is the main presentation of encephalopathy?
mild confusion to coma
in the treatment of alcohol hepatitis, when is steroids given as treatment?
if their glasgow alcohol hepatitis score >9
madders discriminant function >32
why is thiamine given as a treatment for alcohol hepatitis?
70% of patients present malnourished , thiamine (Vitamin B) is given as well as high energy nutrition
how do you investigate wether a patients encephalopathy is due to liver disease or something else?
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
what metabolic syndromes/conditions put people at risk for developing non-alcoholic fatty liver disease?
diabetes mellitus
hypertension
hypertriglyceride
obesity
what percentage of people with NASH develop cirrhosis?
15%