Alcoholic Liver Disease Flashcards
what conditions does alcohol-related liver disease (ArLD) refer to?
- hepatic steatosis
- alcoholic hepatitis
- cirrhosis
what enzyme converts ethanol to acetaldehyde in oxidative metabolism in the liver?
alcohol dehydrogenase
what system converts ethanol to acetaldehyde in the microsomal enzyme oxidative system in the liver?
the cytochrome system
what are the features of alcohol withdrawal?
- 6-12 hours: tremor, sweating, headache, craving + anxiety
- 12-24 hours: hallucinations
- 24-48 hours: seizures
- 48-72 hours: delirium tremens
what is delirium tremens?
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.
what are the symptoms of delirium tremens?
- confusion
- agitation
- delusions
- hallucinations
- tremor
- tachycardia
- hypertension
- hyperthermia
- ataxia
- arrhythmia
what are the features of wernicke’s encephalopathy?
- confusion
- asterixis
- coma
what are the symptoms of alcoholic liver disease?
- jaundice
- anorexia
- fever
- abdominal pain
- ascites
- cachexia
- bruising
- spider naevi
- palmar erythema
- gynaecomastia
what does a blood test show in alcoholic liver disease?
- ↑ MCV
- neutrophilia
- AST:ALT > 2:1
- ? ↑ ALP
- ↑ GGT
- hyperbilirubinaemia
- hypoalbuminaemia
- ↑ INR
- ↑ PT
what is transient elastography (FibroScan) used for?
to assess liver elasticity using high-frequency sound waves + determine the degree of fibrosis
what does a biopsy of the liver show in alcoholic liver disease?
- steatosis
- neutrophil infiltration
- hepatocyte ballooning
- fibrosis
- cholestasis
- mallory-denk bodies
what is the significance of the Maddrey Discriminant Function (DF) score?
- 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%
what are the principles of management for alcoholic liver disease?
- alcohol cessation
- hydration (? albumin)
- nutrition (e.g. thiamine)
- treatment of infection
- pharmacological intervention (e.g. 40mg of prednisolone for 28 days)
what are the long-term complications of alcoholic liver disease?
- acute on chronic liver failure
- hepatic encephalopathy
- bacterial peritonitis
- portal hypertension
- variceal haemorrhage
- HCC
- coagulopathy
- thrombocytopaenia
- ascites
- splenomegaly
- korsakoff’s syndrome
