Alcoholic liver disease Flashcards
What causes some people to get acute liver failure from alcohol?
Poor metabolisation of alcohol in some people
What can alcohol interrupt?
Other metabolic processes e.g. gluconeogenesis
How can alcohol lead to hypoglycaemia and acidosis?
It interrupts other metabolic processes
What is steatosis?
Alcohol related ftty liver disease
What causes steatosis?
Alcohol causing interruption of lipid metabolism, leading to a fatty liver
What is steatohepatitis?
Fatty liver with inflammation
What is the pathology of steatohepatitis?
Neutrophil infiltration of fat leads to inflammation, fibrosis and eventually cirrhosis
How is steatohepatitis diagnosed?
Usually asymptomatic until cirrhotic
Viewed with ultraspund
How is steatohepatitis treated?
Weight loss and exercise
How is alcohol involvement in liver disease determined?
CAGE questions in history
What are the CAGE questions?
Have you ever felt a need to Cut down?
Have you even been Annoyed by criticism of drinking?
Have you even felt Guilty about your drinking?
Do you need an Eyeopener?
What is found on examination with steatosis?
Jaundice
Muscle wasting
Other signs of chronic liver disease
What investigations are done for steatosis?
Labs
Ultrasound
Possible biopsy
Breathalise- help determine alcohol intake
What would labs for steatosis look like?
Raised gamma GT
High AST/ALT ratio
Macrocytosis
Thrombocytopenia
What are the grades of hepatic encephalopathy?
1-4
1= mild cofusion
4= comatose
What causes hepatic encephalopathy?
High ammonia level due to failure of metabolism in liver
Ammonia then crosses blood brain barrier and causes confusion
What is the usual onset of hepatic encephalopathy?
Sudden
What causes sudden hepatic encephalopathy?
Infection Drugs Constipation GI bleed Elcterolyte disturbance
How is hepatic encephalopathy treated?
Treat immediate cause
Supportive care- ICU, airway support, nasogastric tube
What are the signs and symptoms of spontaneous bacterial peritonitis?
Abdo pain
Fever/rigors
Renal impairment
Signs of sepsis
What investigations are carried out for spontaneous bacterial peritonitis?
Ascitic tap- protein and glucose levels, cultures, cell count
What would be altered about the cell count of ascitic fluid in spontaneous bacterial peritonitis?
Raised neutrophil count
What is the treatment of spontaneous bacterial peritonitis?
IV antibiotics
Ascitic fluid drainage
IV albumin infusion
What are the signs and symptoms of alcoholic hepatitis?
Jaundice
Encephalopathy
Decompensated hepatic function
How is alcoholic hepatitis diagnosed?
Decompensated hepatic function- raised bilirubin, raised GGT and ALP History of alcohol
Exclude other causes
What is the treatment of alcoholic hepatitis?
Treat any present infections and encephalopathy Supportive care Treat alcohol withdrawal Protect against GI bleeds Nutrition Severe cases may require steroids
