Alcoholic liver disease

Question 1

What are the 3 stages of alcoholic liver disease?

Answer 1

Alcoholic fatty liver (reversible)
Alcoholic hepatitis (reversible if mild)
Alcohol related cirrhosis

Question 2

Describe presentation of alcoholic fatty liver

Answer 2

Asymptomatic
+/-Hepatomegaly

Question 3

When should alcoholic hepatitis be suspected?

Answer 3

Patients with prolonged heavy alcohol use and recent-onset jaundice, fever, leukocytosis + tender hepatomegaly.

Question 4

Give 5 features of presentation of alcoholic hepatitis

Answer 4

Tender hepatomegaly
Acute JAUNDICE
Anorexia
D+V
Febrile (mild)

Question 5

List 5 features of alcohol related cirrhosis

Answer 5

Ascites
Jaundice
Hepatosplenomegaly
Spider naevi
Dupuytrens contracture

Question 6

Describe LFTs in alcoholic hepatitis

Answer 6

high AST
AST > ALT
high GGT
high BR
high ALT
high ALP
low Albumin
prolonged PT

Question 7

What imaging is performed in suspected alcoholic hepatitis?

Answer 7

RUQ doppler US: fatty liver +/or cirrhosis
CT abdo: fatty liver +/or cirrhosis

Question 8

Describe management of alcoholic hepatitis

Answer 8

Alcohol cessation
Nutritional support inc. Pabrinex
+/- Prednisolone
(+/- Pentoxyphylline)

Question 9

What is used to determine who would benefit from prednisolone in alcohol hepatitis? What is needed to calculate this?

Answer 9

Maddrey’s discriminant function (DF)
Calculated using prothrombin time + BR concentration

Question 10

What is alcoholic ketoacidosis?

Answer 10

non-diabetic euglycaemic form of ketoacidosis.

Question 11

How does alcoholic ketoacidosis develop?

Answer 11

Often alcoholics don’t eat regularly + may vomit food they do eat, leading to episodes of starvation. Once malnourished, after an alcohol binge the body starts to break down fat, producing ketones- develops ketoacidosis.

Question 12

Describe biochemistry of alcoholic ketoacidosis

Answer 12

Metabolic acidosis
Elevated anion gap
Elevated serum ketones
Norm/ low glucose

Question 13

Describe management of alcoholic ketoacidosis

Answer 13

IV saline + thiamine

Question 14

List 3 complications of alcoholic hepatitis

Answer 14

Acute liver decompensation
Hepatorenal syndrome
Cirrhosis

Question 15

What is hepatorenal syndrome?

Answer 15

Development of renal failure in pts with advanced chronic liver disease because of abnormalities in blood vessel tone in the kidneys