Alcoholic Liver Disease Flashcards
⚡⚡ MOST COMMON CAUSE of LIVER CIRRHOSIS IN INDIA
⚡⚡ MOST COMMON CAUSE of LIVER CIRRHOSIS IN WESTERN COUNTRIES
⚡⚡ MOST COMMON CAUSE of LIVER CIRRHOSIS IN INDIA
🎯 ALCOHOLIC LIVER DISEASE
⚡⚡ MOST COMMON CAUSE of LIVER CIRRHOSIS IN WESTERN COUNTRIES
🎯 HCV > ALD
1 Standard.Drinks
14 gm Alcohol
18ml of 100% alcohol
Recommended Safe Limit
♂️: ≤ 2 Standard Drink
✨ 20-40 gm/day
♀️: ≤ 1 Standard Drink
✨ 16-30 gm/day
⭐ How much ml of BEER is Standard Drink? (5%)
⭐ How much ml of WINE is Standard Drink? ( 12%)
⭐ How much ml of VODKA, GIN, RUM, WHISKEY is Standard Drink? (40%)
⭐ How much ml of BEER is Standard Drink? (5%)
🎯 350 ml
⭐ How much ml of WINE is Standard Drink? ( 12%)
🎯 150 ml
⭐ How much ml of VODKA, GIN, RUM, WHISKEY is Standard Drink? (40%)
🎯 44 ml
When does a person develops ALCOHOLIC liver DISEASE?
Male:
✨ > 21 standard drinks/wk for ≥ 2 year
✨ > 210 gm/week for ≥ 2 year
Female:
✨ > 14 standard drinks/wk for ≥ 2 year
✨ > 140 gm/week for ≥ 2 year
Pathogenesis of ALCOHOLIC LIVER DISEASE
Effects of ⬆️ NADH DUE TO: Alcohol
Indicates ENERGY FULL STATE in Liver
⬇️
Energy Synthesis
⬇️
Fat synthesis⬆️
⬇️
Steatosis & Steatohepatitis⬆️
ALCOHOLIC Liver DISEASE Spectrum
- Fatty Liver (Steatosis)
- Alcoholic Hepatitis (Steatohepatitis)
- Cirrhosis
- HCC
⚡⚡ MOST COMMON HEPATOTOXIN causing ACUTE LIVER FAILURE
⚡⚡ MOST COMMON HEPATOTOXIN causing CHRONIC LIVER FAILURE
⚡⚡ MOST COMMON HEPATOTOXIN causing ACUTE LIVER FAILURE
🎯 ACETAMINOPHEN
⚡⚡ MOST COMMON HEPATOTOXIN causing CHRONIC LIVER FAILURE
🎯 Alcohol
⭐ DIRECT HEPATOTOXIN
⭐ INDIRECT HEPATOTOXIN
⭐ DIRECT HEPATOTOXIN
🎯 Alcohol
⭐ INDIRECT HEPATOTOXIN
Laennac CIRRHOSIS seen in
⭐ Alcoholic CITRHOSIS
SHOWS HOBNAIL PATTERN
HOBNAIL in MEDICINE
⭐ HOBNAIL PATTERN: ALCOHOLIC CIRRHOSIS (Laennac)
⭐ HOBNAIL CELLS: Collecting Duct (OR) Bellini Duct RCC
⭐ HOBNAIL CELLS: Clear Cell Ovarian Tumour
Identify
Mallory Hyaline Bodies
(OR)
Mallory Denk Bodies
✨ Eosinophilic Inclusion in Hepatocytes
Composition of Mallory Hyaline Bodies
Intermediate Filaments like CK8 & CK18
Mallory Hyaline Bodies found in
🧠⚡ New Indian WATCH⚡
- NASH
- Indian Childhood Cirrhosis
- Wilson’s disease
- Alpha 1 antitrypsin Disease
- Alcoholic Liver Disease
- Tumours: HCC
- 1° biliary Cirrhosis
- hyperplasia: Focal Nodular
Decreased Attenuation in CT Liver
Fatty Liver
USG feature of Alcoholic Fatty Liver
⬆️ LIVER ECHOGENICITY
How to differentiate AFLD & NAFLD
- H/O Alcoholic Liver Disease
- LFT is deranged (AST > ALT)
⚡⚡ MOST COMMON Presentation of ALCOHOLIC fatty liver
Hepatomegaly ± Pain
Liver Profile of ALCOHOLIC FATTY LIVER
- AST/ALT > 1
- Moderate ⬆️ in ALT & AST
- GGT ⬆️ ⬆️
🧑🏻⚕️ Clinical Features of ALCOHOLIC HEPATITIS
Constitutional symptoms (Fever, Fatigue, Anorexia & Tachycardia)
➕
1. Tender Hepatomegaly
2. Jaundice
3. Splenomegaly
4. ASCITES (Portal HTN)
5. Evidence of Liver Failure
LFT in ALCOHOLIC HEPATITIS
- AST & ALT ⬆️ (2-7 x Normal)
- AST/ALT ≥ 2:1
- PT/INR ⬆️
- Bilirubin ⬆️
Alcoholic Hepatitis can be seen on TOP of Liver CIRRHOSIS
Indication of treatment in ALCOHOLIC HEPATITIS
Discrimination Factor ≥ 32
Maddrey Discrimination Score used in
Alcoholic HEPATITIS
✨ For indication of initiation of STEROIDS
Maddrey Discrimination Score
= 4.6*(Prothrombin time - Control Prothrombin Time) ➕ Total Serum Bilirubin
🚫 CONTRAINDICATION of STEROIDS even if MADDREY DISCRIMINATION SCORE ≥ 32
- Active UGI Bleed
- Active Infection
- HBV / HCV
💊💉 MANAGEMENT of ALCOHOLIC HEPATITIS
- Prednisolone: 40mg/day * 18/days ➕ Taper in 16 days
⬇️
Assess after 1 week with Lille’s Score
⬇️
No improvement: Stop Steroids - Pentoxyfylline (PDE ⛔)
Lille’s score
Used to assess Response to STEROIDS in ALCOHOLIC HEPATITIS
MELD Score > 11 indicates
Mortality in 30 days
ABIC Score
Modification of MELD Score
✨ AGE
✨ Bilirubin
✨ INR
✨ Creatinine
ALCOHOLIC CIRRHOSIS
Characteristic Features
✨ Parotid Enlargement
✨ Dupuytren’s contracture
Microvesicular Steatosis
Causes
🧠⚡READ ⚡
- Reye’s Syndrome
- Early ALCOHOLIC liver disease
- Acute Fatty Liver of Pregnancy
- Drugs & Toxins
Macrovesicular Steatosis
🧠⚡NOC PLz ⚡
- NASH
- Obesity
- C HEPATITIS CHRONIC infection
- Protein Energy Malnutrition
- Late ALCOHOLIC Liver Disease
Periportal Predominant Macrovesicular Steatosis
🧠⚡ Total SPACE⚡
- Total Parenteral Nutrition
- Starvation
- Phosphorus poisoning
- AIDS
- Chronic Hepatitis C
- Exogenous Steroids