Alcoholic Liver Disease

Question 1

ALD is the mc of?

Answer 1

liver failure (decompensated cirrhosis)

Question 2

Rf for ALD?

Answer 2

Chronic alcohol, obesity, smoking

Question 3

What happens to the liver in ALD?A

Answer 3

Steatosis (fatty liver - undamaged)
then
Alcoholic Hepatitis (with mallory bodies)
then
Alcoholic cirrhosis (micro nodular)

Question 4

Sx of ALD?
Early and later

Answer 4

Early stages = may show very little symptoms

Later = more severe stages = Chronic liver failure Sx + Alcohol dependency
Jaundice, Hepatosplenomegaly, palmar erythema, Dupuytrens contracture, ascites, HE, spider naevi, caput medusae, easy bruising

Question 5

The alcohol dependency questionnaire includes 2 things?

Answer 5

CAGE
AUDIT

Question 6

What is CAGE?
how many points suggests dependency?

Answer 6

should you CUT down drinking?
are people ANNOYED by your drinking?
feel GUILTY about drinking?
drinking in morning = EYE OPENER

> 2 = dependent

Question 7

What is AUDIT?

Answer 7

10 questions, alcohol use disorder ID test

Question 8

Which is used as first line?

Answer 8

AUDIT but longer

Question 9

Diagnosis of ALD?

Answer 9

Bloods:
LFT = high bilirubin, low albumin, high PT, HIGH GGT (AST:ALT >2)
FBC = Macrocytic non megaloblastic anemia (folate may be low too)

Biopsy:
Needed to confirm extent of cirrhosis or whether simply hepatitis

Question 10

What would the biopsy show in ALD?

Answer 10

Inflammation, necrosis, MALLORY CYTOPLASMIC INCLUSION BODIES

Question 11

Tx for ALD?
Conservative, pharmalogical and surgical

Answer 11

Conservative = STOP ALCOHOL, healthy diet, lower BMI

Pharmacological = Consider steroids short term (eg. prednisolone), B1 and folate supps

Surgical = liver transplant for end stage but must abstain from drinking for 3+ months before consideration

+manage complications

Question 12

What is given to a Px once told to completely stop drinking alcohol? Why are they given that?

Answer 12

give chlordiazepoxide or diazepam for delirium tremors (withdrawal Sx)

Question 13

What are some withdrawal Sx?

Answer 13

Tremors, agitation, ataxia, disorientation

Question 14

Complication of ALD

Answer 14

Pancreatitis (IgE + SMASHED)
HE - lactulose
Ascites - Diuretics
HCC - chemo/surgery
Mallory weiss tear
Wernicke Korsakoff syndrome

Question 15

What is Wernicke Korsakoff syndrome?
Sx?
Tx?

Answer 15

Combined B1 def (alcohol causes B1 def) and alcohol withdrawal symptoms

Ataxia, nystagmus, encephalopathy, high disproportional memory loss

IV Thiamine (or aspabrinex)

Question 16

With Wernicke Korsakoff syndrome, a Px may be Confabulational?
what is this?

Answer 16

Make up stories to fill in the gaps in memory

disproportional increased memory loss compared to other Sx

Question 17

What is 1 unit equivalent to in g and ml?

Answer 17

8g or 10 ml

Question 18

what is the max recommendation for unit of alcohol a week?

Answer 18

14 units max

Question 19

What is the equation for units?

Answer 19

Strength (ABV) x Vol/mL /1000