Alcoholic Liver Disease

Question 1

What are the effects of alcohol on the liver?

Answer 1

Encephalopathy

Spontaneous bacterial peritonitis

Alcoholic hepatitis

Fatty liver disease

Question 2

What are signs of chronic liver disease?

Answer 2

•Spider naevi, palmar erythema, gynaecomastia, loss of axillary and pubic hair, ascites, encephalopathy

Jaundice

Muscle wasting

Majority - no physical findings until advanced disease

Question 3

What discoveries are made in the laboratory about alcoholic liver disease?

Answer 3

–Aspartate Amino Transferase (AST) > alanine Amino Transferase (ALT). Ratio >2

–Raised Gamma Glutamyl Transferase

–Macrocytosis (enlargement of red blood cells with near-constant hemoglobin concentration)

–Thrombocytopenia (low platelets)

Question 4

What imaging technique is used to find out if the liver is fatty?

Answer 4

USS

Question 5

How is hepatic encephalopathy graded?

Answer 5

Question 6

What are the causes of hepatic encephalopathy?

Answer 6

•Causes

–Infection

–Drugs

–Constipation

–GI Bleed

–Electrolyte Disturbance

Question 7

What types of encephalopathy do you need to exclude when trying to diagnose hepatic encephalopathy?

Answer 7

•Exclude

–Infection

–Hypoglycaemia

–Intra Cranial Bleed

Question 8

What is the treatment for hepatic encephalopathy?

Answer 8

•Treatment

–Bowel clear out, lactulose, enemas.

–Antibiotics

–Supportive

• ITU, airway support
• Nasogastric tube for meds

Question 9

What are features of spontaneous bacterial peritonitis?

Answer 9

Abdominal pain

Fever, rigors

Renal Impairment

Signs of sepsis, techycardia, temperature

Question 10

How do we diagnose spontaneous bacterial peritonitis?

Answer 10

• Ascitic tap

Fluid protein and glucose levels

Cultures

White cell count

Question 11

What is the treatment of spontaneous bacterial peritonitis?

Answer 11

IV antibiotics

Ascitic fluid drainage

IV albumin infusion (20% ALBA)

Question 12

What is the presentation of alcoholic hepatitis?

Answer 12

Jaundice

Encephalopathy

Infection common

Decompensated hepati function (low albumin and raised prohrombin time / INR)

Question 13

What is the diagnosis of alcoholic hepatitis?

Answer 13

•Diagnosis

–Raised Bilirubin

–Raised GGT and AlkP

–Alcohol History

–Exclude other causes

Question 14

What is the prognosis of alcoholic hepatitis?

Answer 14

40% mortality

If severe up to 90% mortality

Question 15

What is the treatment for alcoholic hepatits?

Answer 15

• Supportive
• Treat infection
• Treat encephalopathy
• Treat alcohol withdrawal
• Protect against GI bleeding
• Airway Protection / ITU care

Steroids - only if grading is severe

Nutritional support - –100% patients with alcoholic hepatitis are malnourished, 33% severely - Thiamine - frequent feeds, high energy requirement

Question 16

What is 5 year mortality rate in alcoholic hepatitis where there is sign of decompensating liver disease (low albumin and raised prothrombin time)

Answer 16

70%

Question 17

What are the two presentations of fatty liver?

Answer 17

Steatosis

Steatohepatits (fat and inflamamtion)

Question 18

What percentage of steatohepatits develops into cirrhosis?

Answer 18

1/4

Question 19

What is the presentation of steatohepatitis?

Answer 19

Asymptomatic

Raised alanin amino transferase

Fatty liver on USS

Liver biopsy

Question 20

What is the treatment for steatohepatitis?

Answer 20

Weight loss and exercise