Alcoholic Liver Disease

Question 1

What are the three stages of alcoholic liver disease?

Answer 1

1. Fatty liver (steatosis)
2. Alcoholic hepatitis (inflammation and necrosis)
3. Alcoholic liver cirrhosis

Question 2

What is the process of the breakdown of alcohol in liver hepatocytes?

Answer 2

1. Alcohol turn down by alcohol dehydrogenase into acetaldehyde.
2. This process also converts NAD+ into NADH, to make more fatty acids and increase fat production in hepatocytes.

Question 3

What are the risk factors for alcoholic liver disease?

Answer 3

Heavy alcohol consumption, hepatitis C, female gender.

Question 4

What is this describing and what is the treatment?

Acute, reversible, asymptomatic liver condition. Hepatomegaly may be present.

Answer 4

Fatty liver - stop alcohol consumption

Question 5

What is this describing and what percentage of cases progress to cirrhosis?
Develops after years of heavy drinking. Painful hepatomegaly, nausea, anorexia.

Answer 5

Alcoholic hepatitis - 80%

Question 6

What are the investigations for suspected alcoholic hepatitis?

Answer 6

1. AST:ALT ratio >2, ALP and GGT increased, low albumin, thrombocytopenia, hypoglycaemia, raised MCV, anaemia from bone marrow suppression, GI bleeding, folate deficiency.
2. Biopsy showing Mallory bodies and neutrophilic infiltrate

Question 7

What is the management for alcoholic hepatitis?

Answer 7

1. Stop alcohol, steroids to help inflammation.

2. Influenza, pneumococcal, hepatitis A and B vaccines indicated.

Question 8

What is this describing?

Destruction of liver architecture and fibrosis. Presents with complications: ascites, jaundice, encephalopathy.

Answer 8

Alcoholic cirrhosis

Question 9

What is the treatment for alcoholic cirrhosis?

Answer 9

1. Ascitic tap to treat SBP
2. Stop alcohol consumption
3. Vitamin K and vitamin B1 (thiamine)
4. Protein diet helps encephalopathy

Question 10

What is the triad for Wernicke’s encephalopathy?

Answer 10

Confusion, ophthalmoplegia, ataxia.

Question 11

As well as the classic triad, what are the additional signs in Wernicke’s encephalopathy?

Answer 11

Hypothermia, hypotension, coma, memory disturbances.

Question 12

What is the most common cause of Wernicke’s encephalopathy?

Answer 12

Thiamine deficiency secondary to alcoholism.

Question 13

What can Wernicke’s encephalopathy progress to not treated?

Answer 13

Korsakoff syndrome - psychosis characterised by memory loss and confabulation.

Question 14

what is the treatment for Wernicke’s encephalopathy/Korsakoff syndrome?

Answer 14

IV pabrinex