Alcoholic liver disease

Question 1

What causes some people to get acute liver failure from alcohol?

Answer 1

Poor metabolisation of alcohol in some people

Question 2

What can alcohol interrupt?

Answer 2

Other metabolic processes e.g. gluconeogenesis

Question 3

How can alcohol lead to hypoglycaemia and acidosis?

Answer 3

It interrupts other metabolic processes

Question 4

What is steatosis?

Answer 4

Alcohol related ftty liver disease

Question 5

What causes steatosis?

Answer 5

Alcohol causing interruption of lipid metabolism, leading to a fatty liver

Question 6

What is steatohepatitis?

Answer 6

Fatty liver with inflammation

Question 7

What is the pathology of steatohepatitis?

Answer 7

Neutrophil infiltration of fat leads to inflammation, fibrosis and eventually cirrhosis

Question 8

How is steatohepatitis diagnosed?

Answer 8

Usually asymptomatic until cirrhotic

Viewed with ultraspund

Question 9

How is steatohepatitis treated?

Answer 9

Weight loss and exercise

Question 10

How is alcohol involvement in liver disease determined?

Answer 10

CAGE questions in history

Question 11

What are the CAGE questions?

Answer 11

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?

Question 12

What is found on examination with steatosis?

Answer 12

Jaundice
Muscle wasting
Other signs of chronic liver disease

Question 13

What investigations are done for steatosis?

Answer 13

Labs
Ultrasound
Possible biopsy
Breathalise- help determine alcohol intake

Question 14

What would labs for steatosis look like?

Answer 14

Raised gamma GT
High AST/ALT ratio
Macrocytosis
Thrombocytopenia

Question 15

What are the grades of hepatic encephalopathy?

Answer 15

1-4
1= mild cofusion
4= comatose

Question 16

What causes hepatic encephalopathy?

Answer 16

High ammonia level due to failure of metabolism in liver

Ammonia then crosses blood brain barrier and causes confusion

Question 17

What is the usual onset of hepatic encephalopathy?

Answer 17

Sudden

Question 18

What causes sudden hepatic encephalopathy?

Answer 18

Infection
Drugs
Constipation
GI bleed
Elcterolyte disturbance

Question 19

How is hepatic encephalopathy treated?

Answer 19

Treat immediate cause

Supportive care- ICU, airway support, nasogastric tube

Question 20

What are the signs and symptoms of spontaneous bacterial peritonitis?

Answer 20

Abdo pain
Fever/rigors
Renal impairment
Signs of sepsis

Question 21

What investigations are carried out for spontaneous bacterial peritonitis?

Answer 21

Ascitic tap- protein and glucose levels, cultures, cell count

Question 22

What would be altered about the cell count of ascitic fluid in spontaneous bacterial peritonitis?

Answer 22

Raised neutrophil count

Question 23

What is the treatment of spontaneous bacterial peritonitis?

Answer 23

IV antibiotics
Ascitic fluid drainage
IV albumin infusion

Question 24

What are the signs and symptoms of alcoholic hepatitis?

Answer 24

Jaundice
Encephalopathy
Decompensated hepatic function

Question 25

How is alcoholic hepatitis diagnosed?

Answer 25

Decompensated hepatic function- raised bilirubin, raised GGT and ALP History of alcohol
Exclude other causes

Question 26

What is the treatment of alcoholic hepatitis?

Answer 26

Treat any present infections and encephalopathy
Supportive care
Treat alcohol withdrawal
Protect against GI bleeds
Nutrition
Severe cases may require steroids