Alcohol Related Liver Disease Flashcards
What is steatosis?
Fatty liver
What is steatohepatitis?
Fatty liver with inflammation
What is the pathology of steatohepatitis?
Neutrophil infiltration, fibrosis and cirrhosis
What is CAGE in reference to alcohol intake?
C-need to cut dowm
A-annoyed by criticism of your drinking
G-guilty about your drinking
E-do you need an eyeopener
What are the signs of chronic liver disease?
Spider naevi, palmar erythema, gynaecomastia, loss of axillary & pubic hair, ascites, encephalopathy, jaundice and muscle wasting
What lab results would suggest alcoholic liver disease?
AAT: ALT ratio greater than 2, raised GGT, macrocytosis and thrombocytopenia
What is hepatic encephalopathy?
Liver failure
What is the grading of hepatic encephalopathy?
Graded 1-4
1 -mild confusion
4 - coma
What are the causes of hepatic encephalopathy?
Infection, drugs, constipation, GI bleed and electrolyte disturbance
What is the treatment of hepatic encephalopathy?
Bowel clear out, lactulose, enemas, antibiotics, ITU, airway support and nasogastric tube for meds
What are the signs and symptoms of spontaneous bacterial peritonitis?
Abdominal pain, fever, rigors, renal impairment and signs of sepsis (tachycardia and temperature)
What tests can be done in an ascetic tap?
Fluid protein, glucose levels, cultures and white cell count
What levels of neutrophil count and protein would suggest spontaneous bacterial peritonitis?
Neutrophil Count > 0.25x10^9/L
Protein <25/L
What is the treatment of spontaneous bacterial peritonitis
IV antibiotics, ascetic fluid drainage and IV albumin (20%)
What is the presentation of alcoholic hepatitis?
Jaundice, encephalopathy, infection and decompensated hepatic function (low albumin and raised prothrombin time/INR)
What factors would lead to a diagnosis of alcoholic hepatitis?
Raised bilirubin, raised GGT and AlkP, alcohol history and exclusion of other causes
What is the treatment of alcoholic hepatits?
Supportive, THIAMINE AND NUTRTION, treat infection, treat encephalopathy, treat alcohol withdrawal, protect against GI bleeding and airway protection/ITU care
When are steroids indicated in alcoholic hepatitis?
Only when they have Glasgow hepatitis score of >9
What are the causes of fatty liver?
Obesity, diabetes, hypercholesterolaemia
What is the presentation of steatohepatitis?
Asymptomatic, raised AAT and fatty liver on USS
What is the treatment of steatohepatitis?
Weight loss and exercise
