Alcoholic Liver Disease Flashcards
How does alcohol cause damage in the liver?
- Alcohol is directly toxic to the liver. Mostly it causes liver failure over chronic exposure, but some people can have acute liver failure due to alcohol
- It also interrupts a lot of metabolic processes such as gluconeogenesis or lipid metabolism
How does alcohol cause steatosis?
Interruption to the lipid metabolism pathway leads to a fatty liver even if your not fat
What is steatohepatitis?
A fatty liver causing inflammation
This can lead to fibrosis and eventually cirrhosis
What are NAFLD/NASH?
Non-Alcoholic Fatty Liver Disease
Non-Alcoholic Steatohepatitis
Caused by obesity and related diseases e.g. diabetes and hypercholesterolaemia
How do we detect steatohepatitis and treat it?
Ultrasound
~maybe a biopsy
Raised ALT
Treat with weight loss, exercise and abstinence if alcohol induced
How do we gain information about alcohol & dependancy from a patient?
- History
- Use of CAGE questions
- Fast/Audit questionnaire about alcohol intake/effects
What are hte cage questions?
Just a few questions that help determine someones dependance on alcohol:
- ever felt the need to Cut down
- Annoyed by criticism of your drinking?
- Guilty about your drinking?
- need an Eyeopener? (morning drink)
What are the signs/symptoms of alcohol induced liver disease?
Jaundice, muscle wasting and other signs of chronic liver disease
Mostly dont show up until advanced disease
What are the common signs of chronic liver disease?
Spider naevi
palmar erythema
gynaecomastia
loss of axillary and pubic hair
ascites
encephalopathy
What are the signs of alcholic liver disease in the lab tests??
- A high AST/ALT ratio is almost always an indicator of alcohol abuse
- Raised Gamma GT
- Macrocytosis (Enlarged RBCs)
- Thrombocytopenia (low platelets)
Macrocytosis?
Enlarged RBCs
How does hepatic encephalopathy relate to alcoholsim?
A common feature of liver failure, its not alcohol specific but very common in alocholic liver disease
How does hepatic encephalopathy occur?
Confusion due to ammonia in the brain
Normally the liver breaks down ammonia to urea.
Something happens to cause a rise in ammonia and the damaged liver fails to keep up causing acute hepatic encephalopathy
What are common causes for ammonia levels rising in the body?
= Infection
= Drugs
= Constipation
= GI bleed
= Electrolyte Disturbance
How do constipation and GI bleeds cause a rise in ammonia?
Faeces and blood in the gut give off/ break down to ammonia which we reabsorb into the portal circulation