Alcoholic Liver Disease

Question 1

How many people suffer from alcohol dependence globally

Answer 1

140 million

Question 2

How many people suffer from alcohol dependence globally

Answer 2

140 millino

Question 3

What diseases are encompassed in Alcoholic liver disease (ALD)

Answer 3

Fatty liver
Alcoholic hepatitis
Cirrhosis

Question 4

What is the main risk factor for ALD

Answer 4

The quantity and duration of alcohol ingestion

Question 5

What is the male to female ratio of ALD

Answer 5

11:4

Question 6

Why are women more susceptible than men to the harmful effects of alcohol

Answer 6

The difference in body water composition

Question 7

What is the main pathogenic mechanism for liver damage

Answer 7

Oxidative stress

Question 8

Where does oxidative stress arise form

Answer 8

Changes in the redoz state of the hepatocytes
Elevation of hepatocyte Kupffer iron
Reactive acetaldehyde derivatives
Mitochondrial damage
Reduced cellular antioxidants
Alterations in intracellular signalling
Action of inflammatory cytokines, adipokines and hormones

Question 9

Describe what is meant by fatty liver

Answer 9

Initial, reversible effect

consists of the accumulation of cytpoplasmic macrovesicular triglyceride droplets which displace the nucleus

Question 10

Describe what is meant by Alcoholic hepatitis

Answer 10

The next step after fatty liver

results from the combination of fatty liver and inflammation with necrosis of hepatocytes

Question 11

Describe what is meant by Cirrhosis

Answer 11

This occurs when advanced liver disease disrupts the normal liver architecture
Collagen fibrosis of the terminal venules compromises perfusion and contributes to portal hypertension

Question 12

What does Zieve’s syndrome refer to

Answer 12

A clinical state distinct from the normal progression of disease.
Alcohol excess with alcoholic hepatitis, haemolysis, jaundice, abdominal pain, hyperlipidaemia

Question 13

What are clinical features of a fatty liver

Answer 13

Generally asymptomatic

Occasionnaly may cause anorexia, nausea and RUQ pain

Question 14

What are the clinical features of alcoholic hepatitis

Answer 14

Tiredness
Heatpmegaly
Ascites
Mild liver enzyme abnormalities
Severity: encepahalopathy or jaundice and elevated INR
Histology: Mallory’s hyaline, balloon degeneration, neutrophil infiltration

Question 15

What is the treatment for alcoholic hepatitis

Answer 15

Prednisolone for moderate-severe disease

Question 16

What are some of the alternative treatments for alcoholic hepatitis

Answer 16

Pentoxifylline which is though to work through an anti-TNF mechanism

Question 17

What are some of the investigations for ALD

Answer 17

No specific test:
GGT - increases due to enzyme induction
MCV - Macrocytosis is a result of the effects of folate deficiency and alcohol on the bone marrow

Question 18

What is the management of alcoholic ALD

Answer 18

Abstinence is the mainstay of treatment 
Supportive care
Nutritious diet
vitamin supplementation 
withdrawl from alcohol is treated with benzodiazepines
Corticosteroids is controversial

Question 19

What is the prognosis for ALD

Answer 19

Once cirrhosis develops, patients who abstain have a 5 year survival rate of 60-70% which falls to 40% in those who continue to drink

Question 20

What is the management of alcoholic ALD

Answer 20

Abstinence is the mainstay of treatment 
Supportive care
Nutritious diet
vitamin supplementation 
withdrawal from alcohol is treated with benzodiazepines
Corticosteroids is controversial

Question 21

What are clinical features of a fatty liver

Answer 21

Generally asymptomatic

Occasionally may cause anorexia, nausea and RUQ pain

Question 22

What are the clinical features of alcoholic hepatitis

Answer 22

Tiredness
Hepatomegaly
Ascites
Mild liver enzyme abnormalities
Severity: encepahalopathy or jaundice and elevated INR
Histology: Mallory’s hyaline, balloon degeneration, neutrophil infiltration