Alcoholic Hepatitis Flashcards
What are the gastro symptoms of alcoholic hepatitis?
- Increased TPR
- Tender hepatomegaly
- Jaundice
- Bleeding
- Ascites
What are the general symptoms of alcoholic hepatitis?
- Malaise
- Anorexia
- DandV
What triad makes up severe hepatitis?
Jaundice, encepholopathy or coagulopathy
What bloods do you order for alcoholic hepatitis and what are their levels like?
- High WCC
- High INR
- High AST
- High MCV
- High urea
- Low platelets
What is the management for alcoholic hepatitis?
- Hospitalisation, urinary catheter and CVP monitoring
- Screen for infections ± ascites fluid tap and treat for SBP
- Stop alcohol consumption: oral route chlordizepoxide or IM lorazepam
- Vit K, Thiamine, Vit B
- Nutrition: not low protein diet even with severe encephalopathy
- Daily weight, LFT, U+E, INR
What score is used and what does it indicate in alcoholic hep?
Maddery Score: >31 + encephalopathy consider steroids
What is the prognosis of alcoholic hepatitis like?
- Mild episodes don’t affect mortality
- Severe: mortality x50% at 30d
- 1 yr after admission with alcoholic hepatitis 40% are dead
- 80% progress to cirrhosis
What are the 3 stages of liver damage in alcoholic liver disease?
- Fatty liver (steatosis)
- Alcoholic hepatitis (inflammation and necrosis)
- Alcoholic liver cirrhosis
When does steatosis happen?
- After a few days of heavy drinking
- No symptoms
When does alcoholic hepatitis happen?
after long term alcohol use, but sometimes after binge
What are symptoms for alcoholic hepatitis?
- Nausea
- Anorexia
- Weight loss
- Hepatomegaly
What are the features of severe alcoholic hepatitis?
- fever
- jaundice
- tachycardia
- tender hepatomegaly
- bruising
- encephalopathy
- ascites
Is cirrhosis reversible?
no
What is the damage in alcoholic liver disease mediated by?
consumption of NAD+ which promotes fatty infiltration and leads to inflammation
What is alcohol dehydrogenase?
- hepatic enzyme that converts alcohol to acetaldehyde
3. that is metabolised to acetate by the mitochondrial enzyme acetaldehyde dehydrogenase
What does Alcohol dehydrogenase and acetaldehyde dehydrogenase do?
reduce nicotinamide adenine dinucleotide (NAD) to NADH (reduced form of NAD)
What does the excessive NADH in related to NAD inhibit?
inhibits gluconeogenesis and increases fatty acid oxidation, which in turn promotes fatty infiltration in the liver (steatosis)
How else is alcohol damage caused?
- Oxygen free radical production through CYPP-450 2E1
2. Hepatocyte TNF-a production induces oxygen free radical production
What would FBC show in alcoholic hep?
macrocytic anaemia
What would LFTs show in alcoholic hep?
- AST/ALT ratio >2
- HIGH bilirubin
- -/↑ALP
- HIGH GGT
- LOW albumin
What would clotting screen show for alcoholic hep?
INCREASED prothrombin time sensitive marker of significant liver damage
What imaging can be done for alcoholic hep?
hepatic USS
Why is hepatic USS performed?
- performed in cirrhotic patients to screen for hepatocellular carcinoma but is not the first line investigation (LFTs are)
- USS may also show hepatomegaly, fatty liver, liver cirrhosis, liver mass, splenomegaly, ascites, evidence of portal hypertension
What is the diagnostic, but rarely needed test for alcoholic hep?
liver biopsy
What does liver biopsy show in alcoholic hep?
Balloning and Mallory bodies indicates hepatitis - which are damaged intermediate filaments inside hepatocytes
What do you give in severe alcoholic hep?
steroids
What is the management for alcoholic hep?
- Alcohol abstinence + withdrawal management (chlordiazepoxide)
- Nutrition (thiamine- pabrinex, prevent Wernicke-Korsakoff)
- Weight loss/stop smoking
- Steroids in severe alcoholic hepatitis
