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HEPATOPANCREATOBILIARY MEDICINE > ALCOHOLIC LIVER DISEASE > Flashcards

ALCOHOLIC LIVER DISEASE Flashcards

1
Q

What proportion of people who are either psychologically or physically addicted to alcohol develop liver disease?

A

20-30%

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2
Q

What proportion of liver cirrhosis cases are due to alcohol abuse?

A

25%

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3
Q

What are the current guidelines surrounding the maximum weekly number of units of alcohol for men and women?

A

Men - 21

Women - 14

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4
Q

What are the symptoms of alcoholic liver disease?

A 
Nausea
Vomiting
Abdominal pain
Diarrhoea
Jaundice
Complications of cirrhosis
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5
Q

What are the extra-hepatic manifestations of alcoholism?

A 
Wernicke's encephalopathy
Korsakoff's psychosis
Proximal myopathy
Peripheral neuropathy
Cardiomyopathy
Gastritis
Porphyria cutanea tarda
Neglect and malnutrition
Psychosocial difficulties
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6
Q

What is Wernicke’s encephalopathy?

A

Neurological symptoms caused by biochemical lesions of the central nervous system after exhaustion of B-vitamin reserves, in particular thiamine (vitamin B1). Symptoms include confusion, nystagmus, ataxia and ophthalmoplegia.

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7
Q

What is Korsakoff’s psychosis?

A

Acute onset of severe memory impairment without any dysfunction in intellectual abilities caused by a thiamine (vitamin B1) deficiency. It is permanent.

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8
Q

How are people with Wernicke’s encephalopathy managed?

A 
Fluid resuscitation
IV Pabrinex (IV vitamin B1, B2, B3, B6 and C)
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9
Q

What is the quick assessment tool used to screen for alcohol dependency?

A

CAGE questionnaire

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10
Q

What are the 4 elements of the CAGE questionnaire, used to screen for alcohol dependency?

A

Have you ever:

Cut down on alcohol for any reason
become Angry when people discuss your alcohol consumption
felt Guilty because of your alcohol consumption
needed an Eye opener early in the day to help you cope

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11
Q

What are the three main types of liver disease associated with alcohol?

A

Fatty change
Alcoholic hepatitis
Fibrosis

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12
Q

Is the damage done to hepatocellular cells in alcoholic fatty change liver damage temporary?

A

Yes. Abstinence will normally allow this damage to resolve.

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13
Q

What is alcoholic hepatitis?

A

Infiltration with polymorphonuclear leucocytes and hyaline material (Mallory bodies) is typical.

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14
Q

What investigations should be ordered for someone with suspected alcoholic liver disease?

A 
FBC
LFTs
Clotting screen
Ultrasound of liver
Liver biopsy
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15
Q

What would FBC of someone with alcoholic liver disease typically show?

A

Often reveals macrocytosis - sensitive indicator of heavy alcohol consumption.
Leucocytosis is common
Thrombocytopenia - due to toxic effect of alcohol on megakaryocytes

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16
Q

What would the LFTs of someone with alcoholic liver disease typically show?

A 
Raised GGT
Raised AST
Not so raised ALT
Ratio of AST:ALT of over 2
Low albumin
17
Q

What is Zieve syndrome?

A

Liver delipidization that can occur during withdrawal from prolonged alcohol abuse. The symptoms are:

Hemolytic anemia (with spur cells and acanthocytes)
Hyperlipoproteinaemia (excessive blood lipoprotein)
Jaundice
Abdominal pain

18
Q

What would the clotting screen of someone with alcoholic liver disease typically show?

A

Prolonged prothrombin time is typical of alcoholic hepatitis

19
Q

What might ultrasound reveal in someone with alcoholic liver disease?

A 
Fatty change
Macronodular cirrhosis (irregular margin)
20
Q

What might liver biopsy reveal in someone with alcoholic liver disease?

A

Features of cirrhosis and fatty change.

21
Q

What is the gold standard for diagnosing alcoholic liver disease?

A

Liver biopsy

22
Q

How might a liver biopsy in someone with alcoholic liver disease be undertaken and why?

A

Transjugular liver biopsy to reduce the bleeding risk in patients with coagulopathy or low platelet count.

23
Q

What is the 5 year survival rate for someone with alcoholic liver disease?

A

60% if they continue to drink alcohol

90% if they discontinue

24
Q

How are people with alcoholic liver disease managed?

A

Abstinence is key

High protein and calorie supplements should be given, except in cases of hepatic encephalopathy.

25
Q

What is hepatic encephalopathy?

A

Confusion, altered level of consciousness, and coma as a result of liver failure leading to build up of toxins such as ammonia.

26
Q

How is hepatic encephalopathy treated?

A

The nitrogen load from the gut can be reduced using lactulose or bowel enemas.

27
Q

What are the clinical features of acute alcohol withdrawal?

A

Hallucinations
Tremor
Fits
Delirium tremens

28
Q

How should alcohol withdrawal be treated?

A

Benzodiazepines such as diazepam or chlordiazepoxide

HEPATOPANCREATOBILIARY MEDICINE (11 decks)

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