Alcoholic Liver Disease

Question 1

Alcoholic liver disease

Answer 1

• spectrum of ocnditions resulting from overconsumption of alcohol
• leads to inflammation, scarring, destruction of liver

Question 2

Types of alcoholic liver disease

Answer 2

1. Alcoholic fatty liver disease
2. alcoholic hepatitis
3. cirrhosis

Question 3

Pathophysiology of alcoholic liver disease

Answer 3

1. metabolic derangements
2. hepatocellular injury
3. inflammatory response and fibrogenesis

Question 4

Clinical features of alcoholic liver disease

Answer 4

Non-specific:
- malaise, fatigue, weakness
- abdominal pain
- anorexia
- nausea and vomiting

Liver signs

Oestrogen effects (as damage increases, oestrogen increases)

portal hypertension

Question 5

Sequelae of liver disease

Answer 5

• jaundice
• RUQ pain
• hepatomegaly
• palmar erythema
• finger clubbing
• dupytrens contracture
• pruritis
• xanthomas
• spider angiomas
• spider naevi
• peripheral oedema
• caput medusa

Question 6

Oestrogenic effects seen in liver disease

Answer 6

• gynaecomastia
• testicular atrophy
• reduced body hair
• amenorrhoeia
• reduced libido

Question 7

LFT findings in alcoholic liver disease

Answer 7

AST:ALT ratio (2:1)

Question 7

Clinical signs of portal hypertension

Answer 7

• ascites
• caput medusae
• variceal bleeding and haemorrhage
• splenomegaly

Question 8

Differentials of alcoholic liver disease

Answer 8

• non-alcoholic fatty liver (obesity, T2DM, hypertension)
• viral hepatitis (IV drugs, unsafe sex)
• autoimmune (autoantibodies, immunoglobins)

Question 9

Managing alcoholic liver disease

Answer 9

• alcohol abstinence
• weight loss
• vaccinations
• nutrition (high protein diet)
• acute ALD - prednisolone
• end stage - liver transplant (must be alcohol free > 6 months)

Question 10

Complications of alcoholic liver disease

Answer 10

1. hepatic encephalopathy (ammonia accumulation; lactulose)
2. portal hypertension (once cirrhosis established)
3. hepato-renal syndrome
4. hepatocellular carcinoma