Alcoholic hepatitis Flashcards

1
Q

Stepwise progression of alcoholic liver disease

A
  1. Alcohol related fatty liver
  2. Alcoholic hepatitis
  3. Cirrhosis
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2
Q

Alcohol related fatty liver

A

Drinking leads to a build-up of fat in the liver

If drinking stops this process reverse in around 2 weeks

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3
Q

Alcoholic hepatitis

A

Drinking over long period causes inflammation in liver sites

Binge drinking associated with same effect

Mild alcoholic hepatitis usually reversible with permanent abstinence

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4
Q

Cirrhosis

A

Liver made up of scar tissue rather than healthy liver tissue

Irreversible

Stopping drinking prevents further damage

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5
Q

Investigations findings

A

Gamma-GT is characteristically elevated

Ratio of AST:ALT normally >2 (>3 strongly suggestive of acute alcoholic hepatitis)

Elevated prothrombin time due to reduced synthetic function

U&Es may be deranged in hepatorenal syndrome

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6
Q

Complications of alcohol

A

Alcoholic liver disease

Cirrhosis and complications (hepatocellular carcinoma)

Alcohol dependence and withdrawal

WEnicke-Korsakoff syndrome

Pancreatitis

Alcoholic cardiomyopathy

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7
Q

Signs of liver disease

A

Jaundice

Hepatomegaly

Spider naevi

Palmar erythema

Gynaecomastia

Bruising due to abnormal clotting

Ascites

Caput medusae

Asterixis

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8
Q

US

A

May show fatty changes early described as ‘increased echogenicity’

Fibroscan can check elasticity

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9
Q

Endoscopy

A

Can assess for and treat oesophageal varices when portal hypertension suspected

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10
Q

CT and MRI scans

A

Can look for fatty infiltration of the liver, hepatocellular carcinoma, hepatosplenomegaly, abnormal blood vessel changes and ascites

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11
Q

Liver biopsy

A

NICE recommends when steroid treatment is being considered

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12
Q

General management

A

Stop drinking

Consider detox regime

Nutritional support with thiamine and high protein

Steroids short term

Pentoxyfilline sometimes used

Treat complications

Referral for liver transplant if severe disease and abstain from alcohol for 3 months

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13
Q

Steroid use

A

Glucocorticoids often used in acute episodes

Maddrey’s discriminant function used to determine who would benefit

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