alcoholic liver disease Flashcards
what is the stepwise progression of alcoholic liver disease?
- alcohol related fatty liver- build up of fat in the liver, which stops when drinking stops
- Alcoholic hepatitis- inflammation of the liver, mild alcoholic hepatitis can be reversible with permanent abstinence
- cirrhosis- liver becomes scared and this is ireversible- continued drinking makes it worse
what are the CAGE questions?
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?
what will the bloods look like for alcoholic liver disease?
- FBC – raised MCV
- LFTs – elevated ALT and AST (transaminases) and particularly raised gamma-GT. ALP will be elevated later in the disease. Low albumin due to reduced “synthetic function” of the liver. Elevated bilirubin in cirrhosis.
- Clotting – elevated prothrombin time due to reduced “synthetic function” of the liver
- U+Es may be deranged in hepatorenal syndrome.
what types of imaging would you do for alcoholic liver disease?
- fibro scan to check for liver elasticity
- endoscopy to check for oesophageal varices
- CT/MRI= to look for fatty infiltration of the liver, hepatocellular carcinoma, hepatosplenomegaly, abnormal blood vessel changes and ascites.
- biopsy can be done to confirm cirrhosis or hepatitis and is usually given before starting steroid treatment
how does alcohol withdrawal progress?
- 6-12 hours: tremor, sweating, headache, craving and anxiety
- 12-24 hours: hallucinations
- 24-48 hours: seizures
- 24-72 hours: “delirium tremens”
what is the pathophysiology of delirium tremens?
- alcohol activates GABA which relaxes the brain and inhibits glutamate- essentially inhibiting electrical activity in the brain
- the brain responds by down regulating GABA and up regulating glutamate to balance the situation
- when alcohol is suddenly taken away the under functioning of GABA and the over functioning of glutamate results in extreme excitability of the brain
what are symptoms of delirium tremens?
- Acute confusion
- Severe agitation
- Delusions and hallucinations
- Tremor
- Tachycardia
- Hypertension
- Hyperthermia
- Ataxia (difficulties with coordinated movements)
- Arrhythmias
what’s the difference between wernickes and korsakoffs?
wernikes happens first and is a medical emergency which can be reversed. if wernickes is not treated it can lead to korsakoffs
what is the triad for wernikes?
- confusion
- ataxia
- opthalmaplegia
what are features of korsikoffs?
- memory impairment
- behavioural change
what is the cause of wernikes?
caused by B1 (thiamine deficiency)
treat with:
Intravenous high-dose B vitamins (pabrinex). This should be followed by regular lower dose oral thiamine.
what is maddreys discriminant function?
Suggests which patients with alcoholic hepatitis may have a poor prognosis and benefit from steroid administration.
uses prothrombin time and bilirubin conc
> 32 - likely to need steroids
what is the steroid regimin for alcoholic hepatitis?
prednisolone 40mg/day for 28 days.
what type of liver function tests would someone with acute alcoholic hepatitis have?
gamma-GT is characteristically elevated
the ratio of AST:ALT is normally > 2, a ratio of > 3 is strongly
why is pentoxyphylline not used as often as steroids for the treatment of acute hepatitis?
the STOPAH study compared pentoxyphylline and prednisolone.
It showed that prednisolone improved survival at 28 days and that pentoxyphylline did not improve outcomes
