Alcoholic Liver Disease

Question 1

Symptoms of alcoholic liver disease

Answer 1

Reduced appetite
Diarrhoea
Puritis

Question 2

Signs of alcoholic liver disease

Answer 2

Jaundice 
Signs of anaemia
Palmar erythema 
Portal hypertension signs: oesophageal varices, ascites, splenomegaly, caput medusae, spider navi 
Bruising (low clotting factors)

Question 3

Investigations of alcoholic liver disease

Answer 3

LFTS: high AST/ALT, high ALP, high bilirubin

FBC: low albumin, anaemia, deranged clottingㄷ

Question 4

Management of alcoholic liver disease

Answer 4

Lifestyle advice: stop drinking alcohol

Disulphram used in chronic alcohol dependence (inhibits aldehyde dehydrogenase)

Treat complications (anaemia etc.)

Liver transplant

Question 5

Complications of alcoholic liver disease

Answer 5

Liver failure 
Hepatocellular carcinoma 
Encephalopathy 
Dementia 
Epilepsy

Question 6

Pathophysiology of alcoholic liver disease

Answer 6

Excessive alcohol depletes NAD+, can’t be used for fatty acid oxidation or conversion of lactate to pyruvate.
Increased NADH also promotes fat storage
Acetaldehyde is toxic to hepatocytes, decreases protein production and fat transport.

Fat builds up in liver -> alcoholic steatosis -> liver fibrosis -> alcoholic cirrhosis