Alcoholic Liver Disease Flashcards
What is Alcoholic Liver Disease (ALD)?
Manifestation of alcohol overconsumption, leading to inflammation and scarring of the liver tissue. More common in males 40-50yrs.
List the types of Alcoholic Liver Disease.
- Alcoholic fatty liver disease
- Alcoholic hepatitis
- Cirrhosis
What are the risks associated with Alcoholic Liver Disease?
- Alcohol consumption
- Genetic predisposition
- Poor diet
- Co-existing liver conditions (Chronic viral hepatitis C, haemochromatosis, AI hepatitis, Wilson’s)
What is the progression of Alcoholic Liver Disease?
Steatosis (fat build up) –> Alcoholic hepatitis –> fibrosis –> cirrhosis
What are the non-specific symptoms of Alcoholic Liver Disease?
- Fatigue and malaise
- Abdominal pain
- Anorexia
- Weakness
- Nausea/Vomiting
What are the symptoms of alcoholic cirrhosis?
- Jaundice
- Pruritis
- RUQ pain
- Hepatomegaly
- Palmar erythema
- Dupuytren’s contracture
- Xanthomas
- Spider Nevi
- Peripheral oedema
- Hepatic encephalopathy
What effects does liver damage have on estrogen levels?
Estrogen levels will rise, leading to symptoms like gynaecomastia, testicular atrophy, loss of body hair, amenorrhoea, and loss of libido.
What is a complication of alcoholic cirrhosis?
Portal hypertension due to scarring and inflammation.
What are the signs of portal hypertension?
- Ascites
- Dilated veins (Caput medusae)
- Oesophageal varices
- Splenomegaly
What initial blood tests are done for Alcoholic Liver Disease?
- FBC
- LFT
- Clotting (INR/PT)
- U&Es
What findings indicate alcoholic liver disease in blood tests?
- AST:ALT ratio > 2:1
- Raised GGT
- Mild rise in bilirubin
- Decreased albumin
What ratio is seen in raised LFTs in alcoholic liver disease?
AST/ALT: 2:1 raised ratio
What is the management aim for Alcoholic Liver Disease?
Prevent and/or slow progression of liver damage.
What are the conservative management strategies for Alcoholic Liver Disease?
- Alcohol cessation
- Weight loss
- Vaccination (Hep A and B)
- Nutrition (high protein)
What medications are used for alcohol withdrawal?
- Benzodiazepines
- Quick-acting benzodiazepines (lorazepam)
What are the stages of alcohol withdrawal symptoms?
- 6-12hrs: tremor, sweating, headaches, craving, anxiety
- 12-24hrs: hallucinations
- 24-48hrs: seizure
- 24-72hrs: delirium tremors
What causes Wernicke’s encephalopathy?
Wernicke’s encephalopathy due to low thiamine (B1)
Alcohol interferes with B1 absorption + alcoholics are often suffer from malnutrition
What is the mortality rate for Delirium Tremens?
35% mortality rate.
What is the first-line treatment for acute alcoholic hepatitis?
Glucocorticoids (prednisolone).
What does Maddrey’s discriminant function identify?
Patients with severe acute alcoholic hepatitis; DF > 32 predicts high mortality within 90 days.
What is the treatment for end-stage Alcoholic Liver Disease?
Liver transplant, must be 6+ months alcohol free.
What is hepatic encephalopathy?
Toxin build-up (ammonia) causing confusion, drowsiness, hyperventilation, astereixis, fetor hepaticus.
What is portal hypertension?
Complication of liver cirrhosis, blockage of blood vessels in liver leading to high pressure in the venous system.
What is hepato-renal syndrome?
Complication of portal hypertension leading to renal failure due to reduced kidney blood flow.
