Alcohol symposium - Liver Flashcards
List some functions of the liver?
Carb, protein & fat metabolism
Alcohol & drug metabolism
Storage of glucose, vit, iron & copper
Synthesis of fibrinogen, thrombopoietin & bile
How is alcohol metabolised in the liver?
Alcohol
-> Acetylaldehyde by Alcohol Dehydrogenase (ADH)
-> Acetate by Acetylaldehyde Dehydrogenase (ALDH)
Other than alcohol intake what other factors affect alcoholic liver disease?
- Poor nutrition
- Simultaneous other drugs
- Genetics
- Female
- Viruses
How does alcohol liver disease progress?
Normal
-> Steatosis (fatty liver)
-> Steatohepatitis
-> Fibrosis
-> Cirrhosis
Is liver damage reversible?
Steatosis is reversible i.e. the fatty change but fibrosis is not
The history of alcohol use is essential but what tests can we do that give us an indicator of chronic alcohol use?
- Elevated Gamma GT
- Elevated Ferritin
- Macrocytosis (Elevated MCV)
- Decreased Platelets
- Enlarged smooth edged liver on US
Acute alcohol use can cause Alcoholic Hepatitis, how does this present?
- Jaundice
- Hepatomegaly
- Abdo pain
- Fever
- Hepatic Decompensation
How do we assess Alcoholic Hepatitis?
Glasgow Alcoholic Hepatitis Score
A measure of 28day surviva;
How do we treat Alcoholic Hepatitis?
Steroids
Treat any infection
Nutrition
ABSTINENCE
How does fibrosis occur?
Chronic inflammation activates stellate cells which then lay down collagen
When does fibrosis become cirrhosis?
When the collagen is laid down bridging lobules leading to loss of normal lobular structure
What are the complications of cirrhosis?
Variceal Haemorrhage
Encephalopathy
Ascites
Hepatocellular Carcinoma
If you’re already cirrhotic is it really worth abstaining?
YES! even at that stage it doubles 6 month survival
