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Gastrointestinal Block > Alcoholic Liver Disease > Flashcards

Alcoholic Liver Disease Flashcards

1
Q

What is the stepwise progression of alcoholic liver disease

A
  1. Alcohol related fatty liver: build-up of fat in the liver (reversible)
  2. Alcoholic hepatitis: Inflammation (usually reversible)
  3. Cirrhosis: scar tissue (irreversible)
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2
Q

What is the current recommended alcohol consumption?

A

No more than 14 units per week for both men and women

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3
Q

List 2 questionnaires which can be used to screen for harmful alcohol us

A
  1. CAGE Questions
  2. AUDIT Questionnaire
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4
Q

Explain the CAGE questionnaire

A

C – CUT DOWN? Ever thought you should?

A – ANNOYED? Do you get annoyed at others commenting on your drinking?

G – GUILTY? Ever feel guilty about drinking?

E – EYE OPENER? Ever drink in the morning to help your hangover/nerves?

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5
Q

List 4 complications of alcohol

A
  1. Alcoholic Liver Disease
  2. Cirrhosis and the complications ie. hepatocellular carcinoma
  3. Alcohol Dependence and Withdrawal
  4. Wernicke-Korsakoff Syndrome
  5. Pancreatitis
  6. Alcoholic Cardiomyopathy
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6
Q

List 4 signs of liver disease

A
  1. Jaundice
  2. Hepatomegaly
  3. Spider Naevi
  4. Palmar Erythema
  5. Gynaecomastia
  6. Bruising – due to abnormal clotting
  7. Ascites
  8. Caput Medusae – engorged superficial epigastric veins
  9. Asterixis – “flapping tremor” in decompensated liver disease
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7
Q

What Investigations would you do for Liver Failure

A
  1. Bloods
  2. Ultrasound
  3. Endoscopy
  4. CT and MRI scans
  5. Liver Biopsy
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8
Q

What would you look for in bloods for liver failure? (6)

A
  1. FBC – raised MCV
  2. LFTs – ↑ ALT, AST, GGT ( ↑ALP in later disease)
  3. ↓albumin (↓synthetic function)
  4. ↑ bilirubin in cirrhosis
  5. Clotting ↑ PTT (↓synthetic function)
  6. U+Es may be deranged in hepatorenal syndrome
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9
Q

What investigation can be used to assess degree of cirrhosis?

A

FibroScan - checks the elasticity of the liver

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10
Q

Why do an endoscopy for liver failure?

A

To assess for and treat oesophageal varices when portal hypertension is suspected

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11
Q

Why do an USS for liver failure?

A

May show fatty changes early on described as “increased echogenicity”

Can also demonstrate changes related to cirrhosis if present

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12
Q

Why do CT and MRI scans for liver failure?

A

To look for:

  1. Fatty infiltration of the liver
  2. Hepatocellular carcinoma
  3. Hepatosplenomegaly
  4. Abnormal BV changes
  5. Ascites
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13
Q

Why do a Liver Biopsy in a patient with suspected liver failure?

A

To confirm diagnosis of alcohol-related hepatitis or cirrhosis

NICE recommend considering a liver biopsy in patients where steroid treatment is being considered

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14
Q

General Management for a patient with Alcoholic Liver Disease

A
  1. STOP alcohol + manage withdrawal
  2. Prednisolone
  3. Treat complications of cirrhosis
  4. Referral for liver transplant in severe disease
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15
Q

How long must a patient abstain from alcohol for prior to referral for a liver transplant?

A

prior to referral

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16
Q

Describe the symptom timeline of alcohol withdrawl

A

6-12 hours: tremor, sweating, headache, craving and anxiety

12-24 hours: hallucinations

24-48 hours: seizures

24-72 hours: “delirium tremens”

17
Q

What is Delirium Tremens?

A

Medical emergency associated with alcohol withdrawal with a mortality of 35% if left untreated.

18
Q

What is the pathophysiology of Delirium Tremens

A
  1. Alcohol (+) GABA receptors and (-) glutamate receptors in the brain
  2. Results in inhibitory effect on electrical activity of the brain
  3. Chronic alcohol use down-regulates GABA and up-regulates glutamate
  4. Thus when alcohol is removed, GABA under-functions and glutamate over-functions causing extreme excitability and excess adrenergic activity
19
Q

How does Delirium Tremens present?

A
  1. Acute confusion
  2. Severe agitation
  3. Delusions and hallucinations
  4. Tremor
  5. Tachycardia
  6. Hypertension
  7. Hyperthermia
  8. Ataxia
  9. Arrhythmias
20
Q

How do we manage alcohol withdrawal

A
  1. CIWA-Ar tool (Clinical Institute Withdrawal Assessment – Alcohol revised) to score withdrawal symptoms and guide treatment
  2. Chlordiazepoxide - benzodiazepine
  3. IV Panbrinex IV (high-dose B vitamins, followed by regular lower dose Oral Thiamine
21
Q

Alcohol excess leads to what deficiency?

What is the clinical name of this condition and how does it progress?

A

Thiamine (vitamin B1) → Wernicke-Korsakoff Syndrome

Wernicke’s encephalopathy comes before Korsakoffs syndrom

22
Q

List 3 features of Wernicke’s encephalopathy? (NOAs)

A
  1. Nystagmus
  2. Ophthalmoplegia
  3. Ataxia
23
Q

List 3 features of Korsakoffs syndrome (ARC)

A
  1. Anterograde memory loss
  2. Retrograde memory loss
  3. Confabulation
24
Q

What is the importance of recognising WKS

How do we prevent this?

A

Wernicke’s encephalopathy is a medical emergency and has a high mortality rate if untreated.

Korsakoffs syndrome is irreversible and results in full time institutional care.

Prevention and treatment involve thiamine supplementation and abstaining from alcohol

Gastrointestinal Block (26 decks)

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