Alcoholic Liver Disease Flashcards

1
Q

what conditions does alcohol-related liver disease (ArLD) refer to?

A
  • hepatic steatosis
  • alcoholic hepatitis
  • cirrhosis
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2
Q

what enzyme converts ethanol to acetaldehyde in oxidative metabolism in the liver?

A

alcohol dehydrogenase

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3
Q

what system converts ethanol to acetaldehyde in the microsomal enzyme oxidative system in the liver?

A

the cytochrome system

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4
Q

what are the features of alcohol withdrawal?

A
  • 6-12 hours: tremor, sweating, headache, craving + anxiety
  • 12-24 hours: hallucinations
  • 24-48 hours: seizures
  • 48-72 hours: delirium tremens
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5
Q

what is delirium tremens?

A

chronic alcohol use down-regulates the GABA system and up-regulates the glutamate system. upon alcohol withdrawal, GABA under-functions and glutamate over-functions, leading to brain hyperexcitability and excessive adrenergic activity.

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6
Q

what are the symptoms of delirium tremens?

A
  • confusion
  • agitation
  • delusions
  • hallucinations
  • tremor
  • tachycardia
  • hypertension
  • hyperthermia
  • ataxia
  • arrhythmia
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7
Q

what are the features of wernicke’s encephalopathy?

A
  • confusion
  • asterixis
  • coma
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8
Q

what are the symptoms of alcoholic liver disease?

A
  • jaundice
  • anorexia
  • fever
  • abdominal pain
  • ascites
  • cachexia
  • bruising
  • spider naevi
  • palmar erythema
  • gynaecomastia
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9
Q

what does a blood test show in alcoholic liver disease?

A
  • ↑ MCV
  • neutrophilia
  • AST:ALT > 2:1
  • ? ↑ ALP
  • ↑ GGT
  • hyperbilirubinaemia
  • hypoalbuminaemia
  • ↑ INR
  • ↑ PT
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10
Q

what is transient elastography (FibroScan) used for?

A

to assess liver elasticity using high-frequency sound waves + determine the degree of fibrosis

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11
Q

what does a biopsy of the liver show in alcoholic liver disease?

A
  • steatosis
  • neutrophil infiltration
  • hepatocyte ballooning
  • fibrosis
  • cholestasis
  • mallory-denk bodies
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12
Q

what is the significance of the Maddrey Discriminant Function (DF) score?

A
  • used to assess the severity of alcoholic hepatitis
  • based on serum bilirubin and PT
  • a DF score ≥ 32 indicates severe alcoholic hepatitis, with a 28-day mortality of 25-45%
  • a DF score < 32 indicates mild-to-moderate alcoholic hepatitis, with a 1-3 month mortality of <10%
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13
Q

what are the principles of management for alcoholic liver disease?

A
  • alcohol cessation
  • hydration (? albumin)
  • nutrition (e.g. thiamine)
  • treatment of infection
  • pharmacological intervention (e.g. 40mg of prednisolone for 28 days)
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14
Q

what are the long-term complications of alcoholic liver disease?

A
  • acute on chronic liver failure
  • hepatic encephalopathy
  • bacterial peritonitis
  • portal hypertension
  • variceal haemorrhage
  • HCC
  • coagulopathy
  • thrombocytopaenia
  • ascites
  • splenomegaly
  • korsakoff’s syndrome
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