Alcohol Related Liver Disease

Question 1

What is steatosis?

Answer 1

Fatty liver

Question 2

What is steatohepatitis?

Answer 2

Fatty liver with inflammation

Question 3

What is the pathology of steatohepatitis?

Answer 3

Neutrophil infiltration, fibrosis and cirrhosis

Question 4

What is CAGE in reference to alcohol intake?

Answer 4

C-need to cut dowm
A-annoyed by criticism of your drinking
G-guilty about your drinking
E-do you need an eyeopener

Question 5

What are the signs of chronic liver disease?

Answer 5

Spider naevi, palmar erythema, gynaecomastia, loss of axillary & pubic hair, ascites, encephalopathy, jaundice and muscle wasting

Question 6

What lab results would suggest alcoholic liver disease?

Answer 6

AAT: ALT ratio greater than 2, raised GGT, macrocytosis and thrombocytopenia

Question 7

What is hepatic encephalopathy?

Answer 7

Liver failure

Question 8

What is the grading of hepatic encephalopathy?

Answer 8

Graded 1-4
1 -mild confusion
4 - coma

Question 9

What are the causes of hepatic encephalopathy?

Answer 9

Infection, drugs, constipation, GI bleed and electrolyte disturbance

Question 10

What is the treatment of hepatic encephalopathy?

Answer 10

Bowel clear out, lactulose, enemas, antibiotics, ITU, airway support and nasogastric tube for meds

Question 11

What are the signs and symptoms of spontaneous bacterial peritonitis?

Answer 11

Abdominal pain, fever, rigors, renal impairment and signs of sepsis (tachycardia and temperature)

Question 12

What tests can be done in an ascetic tap?

Answer 12

Fluid protein, glucose levels, cultures and white cell count

Question 13

What levels of neutrophil count and protein would suggest spontaneous bacterial peritonitis?

Answer 13

Neutrophil Count > 0.25x10^9/L

Protein <25/L

Question 14

What is the treatment of spontaneous bacterial peritonitis

Answer 14

IV antibiotics, ascetic fluid drainage and IV albumin (20%)

Question 15

What is the presentation of alcoholic hepatitis?

Answer 15

Jaundice, encephalopathy, infection and decompensated hepatic function (low albumin and raised prothrombin time/INR)

Question 16

What factors would lead to a diagnosis of alcoholic hepatitis?

Answer 16

Raised bilirubin, raised GGT and AlkP, alcohol history and exclusion of other causes

Question 17

What is the treatment of alcoholic hepatits?

Answer 17

Supportive, THIAMINE AND NUTRTION, treat infection, treat encephalopathy, treat alcohol withdrawal, protect against GI bleeding and airway protection/ITU care

Question 18

When are steroids indicated in alcoholic hepatitis?

Answer 18

Only when they have Glasgow hepatitis score of >9

Question 19

What are the causes of fatty liver?

Answer 19

Obesity, diabetes, hypercholesterolaemia

Question 20

What is the presentation of steatohepatitis?

Answer 20

Asymptomatic, raised AAT and fatty liver on USS

Question 21

What is the treatment of steatohepatitis?

Answer 21

Weight loss and exercise