Alcoholic Liver DIsease

Question 1

What is hepatic steatosis?

Answer 1

Alcoholic fatty liver

-early and reversible ALD

Question 2

What is alcoholic hepatitis?

Answer 2

Inflammation of the liver
CPx:
-jaundice, malaise, hepatomegaly
Biochemistry:
-elevated markers
Histology:
-ballooning hepatocyte necrosis
-mallory bodies

Question 3

What is Alcoholic cirrhosis?

Answer 3

Decompensated cirrhosis with ascites, jaundice and
ecephalopathy.

biochemistry:

• ALT and AST mildly elevated
• elevated bilirubin
• decreased albumin

Histology:
-bands of fibrosis surround normal hepatocytes

Question 4

What is a major risk factor for Hepatocellular carcinoma?

Answer 4

Liver cirrhosis

Question 5

How is ALD managed?

Answer 5

• brief intervention
• drugs: Acamprostate, Antabuse, Prednisolone
• nutrition (thiamine)
• Spironolactone and Furesemide (for ascites)
• Propanolol (for varices)
• Lactulose (reduce ammonia - ecephalopathy)

Question 6

What are the indicators for referral to secondary care of patients with ALD?

Answer 6

• new onset ascites
• jaundice
• cirrhotic liver on ultrasound scan
• another liver pathology (Hep C etc)
• persistently abnormal LFTs
• GI bleeding

Question 7

What are the cutaneous stigmata of liver disease?

Answer 7

spider naevi
palmar erythema
clubbing
hairloss

Question 8

Liver biomarkers in ALD?

Answer 8

Gamma GT
Mean cell volume
AST and ALT
AST:ALT ratio (>2)

Question 9

What is the FRAMES structure of a brief intervention?

Answer 9

• Feedback (assess the risks of alcohol problems).
• Responsibility (drinking is patient’s choice)
• Advice (how to change drinking behaviour)
• Menu (options available)
• Empathy (understanding, reflective)
• Self-efficacy (you can achieve your goals!)

Question 10

What enzymes are involved in alcohol metabolism?

Answer 10

Alcohol dehydrogenase
aldehyde dehydrogenase
Catalase
Cytochrome p450

Question 11

What is the progression of symptoms in ALD? (from steatosis, through hepatitis to cirrhosis)

Answer 11

malaise
nausea
hepatomegaly
fever
jaundice
sepsis
ecephalopathy
ascites
renal failure
death

Question 12

Sings of chronic liver disease?

Answer 12

spider naevi
fetor
encephalopathy
prolonged prothrombin time
hypoalbuminaemia

Question 13

Signs of portal hypertension?

Answer 13

caput medusae
hypersplenism
low platelets

Question 14

What are the features of alcoholic hepatitis?

Answer 14

recent alcohol excess
bilirubin >80umol/L
AST:ALT ration >1.5
hepatomegaly
fever
leucococytosis
hepatic bruit