Alcoholic Liver Disease Flashcards
in the oxidative metabolism pathway what toxic carcinogen can build up?
acetaldehyde
what is steatosis?
fat depositation in the liver
what is steatohepatitis?
fat in the liver with inflammation (neutrophil infiltration, fibrosis, cirrhosis)
what are the signs of chronic liver disease?
> spider naevi > palmar erythema > gynaecomastia > loss of body hair > ascites > encephalopathy
what physical finding could be found in alcohol related liver disease?
> none until advanced liver disease
signs of chronic liver disease
jaundice
muscle wasting
would gamma glutamyl transferase be raised or lowered in alcoholic liver disease?
raised
how would the platelet count be lowered in alcoholic liver disease?
lowered (thrombocytopenia)
what investigations would be carried out for alcoholic liver disease?
ultrasound
describe the grading system of hepatic encephalopathy
1 - 4
1: mild confusion
4: coma
what can cause hepatic encephalopathy?
high levels of ammonia in the blood > infection > drugs > constipation > GI bleed > electrolyte disturbance
what causes do you need to exclude when dealing with hepatic encephalopathy?
> infection
hypoglycaemia
intracranial bleed
what treatment is there for hepatic encephalopathy?
> bowel clear out, lactulose, enemas
antibiotics
supportive (ITU, Airways, nasogastric tube)
what are the signs and symptoms of spontaneous bacterial peritonitis?
> abdominal pain > fever > rigors > renal impairment > sepsis > tachycardia > temperature
what investigations would you carry out in spontaneous bacterial peritonitis?
> ascitic tap: fluid protein/glucose levels
cultures
white cell content
what is the management for spontaneous bacterial peritonitis?
> IV antibiotics
ascetic fluid drainage
IV albumin infusion (to stop leakage back into cavity after drain)
how does alcoholic hepatitis present?
> jaundice
enceohalopathy
decompensated hepatic function
infection
what is needed to diagnose alcoholic hepatitis?
> raised bilirubin
raised GGT and AlkP
alcohol history
exclusion of other causes (cancer)
what is the treatment for alcoholic hepatitis?
> supportive > treat infection > treat encephalopathy > treat alcohol withdrawal > protect against GI bleed > protect airways > steroids if grading is severe: Glasgow alcoholic hepatic score >9 > nutritional
what is the prognosis of alcoholic hepatitis dependent on?
abstinence or ongoing alcohol consumption
what is the prognosis of alcoholic hepatitis if there is any sign of decompensating liver disease?
70% mortality in 5years
what is the prognosis of alcoholic hepatitis if encephalopathy is present?
64% in 1 year mortality
what can cause fatty liver?
> diabetes
obesity
hypercholesterolaemia
how many patients with steatohepatitis develop cirrhosis?
1/4
how would you diagnose steatohepatitis?
> raised alanine amino transferase
ultrasound
liver biopsy
what is the treatment for steatohepatitis?
> weight loss
> exercise
