Alcohol Symposium: The Enemy of the Common Man Flashcards
What is the safe amount of alcohol?
There isn’t one
What outcomes of alcohol abuse on the liver are reversible?
Hepatitis
Steatosis
What outcome of alcohol abuse on the liver is not reversible?
Cirrhosis
comes after hepatitis or steatosis
Who has alcoholic fatty liver and what proportion progress to cirrhosis?
Most Heavy drinkers will have Fatty Liver
20% progress to cirrhosis
Alcohol Abstinence improves Fatty Liver to normal
What alcohol intake is required for acute alcoholic hepatitis?
Alcohol intake > 6u / day
What are the clinical signs of AAH and how deadly is it?
Jaundice with Bilirubin > 80mg/dl
No other aetiology for Liver inflammation
Very high Mortality/No specific treatment yet
What is GAHS?
Glasgow alcoholic hepatitis score
What are the outcomes at 30 and 84 days for a GAHS ≥9?
30 day mortality
- Without steroids 48%
- With steroids 22%
84 day mortality
- Without steroids 62%
- With steroids 41%
Describe ARLD hospital admissions
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
What proportion of chronic alcohol user have malnutrition?
60%
Most of the calories are from Alcohol
Total energy intake is reduced
- Nausea & Vomiting
- Abdo pain
- Diarrhoea
What is the mortality rate in alcoholic cirrhosis?
75% die of Liver decompensation
20-25% Hepatocellular cancer sequelae
What are the ARLD survival rates without transplantation?
<50 % 2 year survival without Transplant
ARLD is the most common indication
Other indications:
Resistant complications of Cirrhosis Jaundice Ascites Encephalopathy Coagulopathy Hepatocellular Cancer
How common is cirrhosis in teenagers?
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)
What do you look for in US in suspected liver disease?
CASE STUDIES ON PP
Size Fatty Liver Gall Bladder Portal venous flow direction and any thrombi Spleen size Ascites
What do you look for in the blood in suspected liver disease?
Hepatitis serology Autoantibody profile Coeliac serology Immunoglobulins Lipids Caeruloplasmin (involved in iron metabolism) A1AT
What may cause reduced vision in patient with history of alcohol/nicotine use?
Toxic neuropathy
May be nutritional so must check:
- B12
- Folate
- Ferritin
What is a hypechooic lesion on an US?
A dense lesion - possibly liver metastases
What is a possible CT picture in sever ARLD (specifically triple phase CT)?
- 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
What is alpha fetoprotein?
- A tumour marker (molecule in the blood)
- Increased in liver cancer
(and germ cell tumours)
What can spider nave be a sign of?
Liver disease
What is a TIPSS?
Transjugular intrahepatic portosystemic shunt
What is a Sengstaken tube used for?
To slow or stop bleeding from the oesophagus or stomach
What are oesophageal varies causes by?
When normal blood flow to the liver is blocked by a clot or scar tissue in the liver
