Alcohol Symposium: The Enemy of the Common Man

Question 1

What is the safe amount of alcohol?

Answer 1

There isn’t one

Question 2

What outcomes of alcohol abuse on the liver are reversible?

Answer 2

Hepatitis

Steatosis

Question 3

What outcome of alcohol abuse on the liver is not reversible?

Answer 3

Cirrhosis

comes after hepatitis or steatosis

Question 4

Who has alcoholic fatty liver and what proportion progress to cirrhosis?

Answer 4

Most Heavy drinkers will have Fatty Liver

20% progress to cirrhosis

Alcohol Abstinence improves Fatty Liver to normal

Question 5

What alcohol intake is required for acute alcoholic hepatitis?

Answer 5

Alcohol intake > 6u / day

Question 6

What are the clinical signs of AAH and how deadly is it?

Answer 6

Jaundice with Bilirubin > 80mg/dl

No other aetiology for Liver inflammation

Very high Mortality/No specific treatment yet

Question 7

What is GAHS?

Answer 7

Glasgow alcoholic hepatitis score

Question 8

What are the outcomes at 30 and 84 days for a GAHS ≥9?

Answer 8

30 day mortality

• Without steroids 48%
• With steroids 22%

84 day mortality

• Without steroids 62%
• With steroids 41%

Question 9

Describe ARLD hospital admissions

Answer 9

1 person admitted with ARLD / day
Age at presentation is going down
Mean length of stay is 9 days
1 death every 4.5 days at ARI
Mean age at dying 58

Question 10

What proportion of chronic alcohol user have malnutrition?

Answer 10

60%

Most of the calories are from Alcohol

Total energy intake is reduced

• Nausea & Vomiting
• Abdo pain
• Diarrhoea

Question 11

What is the mortality rate in alcoholic cirrhosis?

Answer 11

75% die of Liver decompensation

20-25% Hepatocellular cancer sequelae

Question 12

What are the ARLD survival rates without transplantation?

Answer 12

<50 % 2 year survival without Transplant
ARLD is the most common indication

Other indications:

Resistant complications of Cirrhosis
Jaundice
Ascites
Encephalopathy
Coagulopathy
Hepatocellular Cancer

Question 13

How common is cirrhosis in teenagers?

Answer 13

Rare

-Deranged LFTs are common especially in Obese teenagers

-Exposure to Alcohol <14 yrs
Strongly associated with later alcohol abuse & dependence
(RR 2.3-4.0)

Question 14

What do you look for in US in suspected liver disease?

CASE STUDIES ON PP

Answer 14

Size
Fatty Liver
Gall Bladder
Portal venous flow direction and any thrombi
Spleen size 
Ascites

Question 15

What do you look for in the blood in suspected liver disease?

Answer 15

Hepatitis serology 
Autoantibody profile 
Coeliac serology 
Immunoglobulins
Lipids
Caeruloplasmin (involved in iron metabolism)
A1AT

Question 16

What may cause reduced vision in patient with history of alcohol/nicotine use?

Answer 16

Toxic neuropathy

May be nutritional so must check:

• B12
• Folate
• Ferritin

Question 17

What is a hypechooic lesion on an US?

Answer 17

A dense lesion - possibly liver metastases

Question 18

What is a possible CT picture in sever ARLD (specifically triple phase CT)?

Answer 18

• Features of Liver cirrhosis with Nodularity
• Multiple lesions both lobes of liver
• Portal venous thrombus
• Mass between Spleen/L Kidney
• Ascites
• Bony Metastases to Sternum/10th Rib

Question 19

What is alpha fetoprotein?

Answer 19

• A tumour marker (molecule in the blood)
• Increased in liver cancer

(and germ cell tumours)

Question 20

What can spider nave be a sign of?

Answer 20

Liver disease

Question 21

What is a TIPSS?

Answer 21

Transjugular intrahepatic portosystemic shunt

Question 22

What is a Sengstaken tube used for?

Answer 22

To slow or stop bleeding from the oesophagus or stomach

Question 23

What are oesophageal varies causes by?

Answer 23

When normal blood flow to the liver is blocked by a clot or scar tissue in the liver