Alcoholic Liver Disease Flashcards
1
Q
How does alcohol cause change in liver?
A
Metabolism of ethanol causes increased hepatic fatty acid synthesis and decreases fatty acid oxidation leading to hepatic accumulation of fatty acids.
Changes in redox lead to centrilobular necrosis of hepatic acinus
2
Q
How does alcoholic hepatitis occur?
A
Infiltration by polymorphonuclear leucocytes and hepatocyte necrosis
3
Q
What are the clinical features of fatty liver?
A
- Often no symptoms or signs
- Vague abdo symps of nausea, vomiting and diarrhoea are due to effects of alcohol on GI tract.
- Hepatomegaly can occur, together with other features of CLD.
4
Q
What are the three stages of alcoholic liver disease?
A
- Fatty liver
- Alcoholic hepatitis
- Alcoholic cirrhosis
5
Q
How does alcoholic hepatitis present?
A
- Pt may be well with few symps
- Mild to moderate symptoms of ill-health, occassionally with mild jaundice, may occur.
- Signs include all features of CLD
- Liver biochem - deranged
- More severe cases, often superimposed on alcoholic cirrhosis, pt = ill, jaundiced and ascites. Abdo pain and fever.
6
Q
How is alcoholic cirrhosis seen and diagnosed?
A
- Signs of CLD
- Confirmed on biopsy
- Usually presents with one of complications of cirrhosis
7
Q
What investigations are undertaken in alcoholic liver disease?
A
- FBC - anaemia & MCV increase can indicate recent heavy drinking.
- WCC - leucocytosis
- LFTs
Ultrasound/CT to demonstrate fatty infiltration.
8
Q
What is the management of alcoholic liver disease?
A
- Stop drinking alcohol (hepatitis and cirrhosis for life, fatty liver can return one day if aware of risks)
- IV thiamine to prevent Wernicke-Korsakoff’s encephalopathy.
- Steroid therapy useful in hepatitis
- Transplantation for deteriorating cirrhosis
9
Q
What are the criteria for the Glasgow alcoholic hepatitis score?
A
Age: - </>50 WCC </>15 Urea </> 5 Bilirubin 250 INR 2
