Alcoholic Liver Disease Flashcards
Define alcoholic liver disease
Manifestations of alcohol overconsumption - leading to indlammation and scarring of the liver tissue due to progressive destrucation and regeneration of liver parenchyma.
What are the different subtypes on the spectrum of alcoholic liver disease?
Alcoholic fatty liver disease
Alcoholic hepatitis
Cirrhosis
What is the relevant epidemiology of alcoholic liver disease?
Peak incidence in 40-50yrs
Twice as common in males
Note is less common than non-alcoholic liver fatty liver disease
What are some risk factors for alcoholic liver disease?
Alcohol consumption - chronic and excessive
Genetic predisposition - polymorphism in alcohol metabolism enzymes (alcohol dehydrogenase and aldehyde dehydrogenase)
Nutritional status: malnutrion exacerbates due to reduced hepatocyte regen and impaired immune response
Co-existing liver conditions - chronic viral hepatitis (particularly C)
What are the key clinical features of early-stage alcoholic liver disease?
Asymptomatic or non-specific
Fatigue
Malaise
Abdominal pain
Anorexia
Weakness
Nausea / Vomiting
What are the signs of alcoholic hepatitis?
Jaundice (common)
RUQ pain (common
Hepatomegaly (common) - enlarged and smooth edge but rarely tender to palpation
Palmar erythema
Peripheral oedema
Clubbing
Dupuytren’s contracture
Pruritis
Xanthomas
Spider angiomas
What are the signs of a raised estrogen level in alcoholic liver disease?
Gynaecomastia and testicular atrophy (males)
Amenorrhoea (females)
Loss of libido
Loss of body hair
What are the signs/symptoms of portal hypertension as a result of alcoholic cirrhosis?
Ascites
Dilated veins (caput medusae)
Variceal bleeding and haemorrhage
Splenomegaly
What first line investigations should be done for alcoholic liver disease?
Bloods - LFts, FBCs, clotting studies, serum electrolytes
Alcohol consumption questionnaires - AUDIT to help quantify alcohol intake and harmful behaviour patterns.
What may LFT results show in alcoholic liver disease?
Raised GGT
Raised AST
AST:ALT ratio greater than 2:1 (greater than 3:1 indicates acute)
AST - typically 100-2000IU
Mild elevation in bilirubin and decreased albumin
What are the second line investigations that may be done in alcoholic liver disease?
Imaging - US abdo - liver size, exhotexture, rule out malignancy/gallstones, cirrhosis or portal hypertension
Liver biopsy - if concurrent liver disease suspected.
What are some common complications of alcoholic liver disease?
- Hepatic encephalopathy
- Portal hypertension (from cirrhosis) - secondary variceal haemorrhage
- Ascites complications by spontaneous bacterial peritonitis.
- Hepato-renal syndrome - can lead to acute kidney failure due to widespread splanchnic vasodilation
- Hepatocellular carcinoma - hepatic ultrasound every 6m or 1yr to screen
Give an overview of hepatic encephalopathy
Reduced ability of liver to process ammonia
Build up of ammonia can cause encephalopathy
Signs and symptoms - confusion, drowsiness, hyperventilation, asterixis, fetor hepaticus.
Manage supportively and with lactulose.
What are the key differential diagnosis for alcoholic liver disease?
- Non-alcoholic liver disease - more strongly associated with obesity, T2DM, hyperlipidemia and HTN
- Viral hepatitis - serological markers, drug use, unsafe sexual practices
- Autoimmune hepatitis - autoantibodies (ANA, SMA, LKM1), elevated IgG
What are the general measures that should be taken to treat alcoholic liver disease?
Alcohol abstinence - biggest prognostic factor
Weight loss - if overweight or obese may also have NAFLD
Vaccination - hep A and Hep B
Nutrition - high protein (1-1.5g per kg), may need NGT
