Alcoholic liver disease

Question 1

What is alcoholic liver disease?

Answer 1

A term describing the liver manifestations of alcoholism, encompassing fatty liver, alcoholic hepatitis and chronic hepatitis.

Question 2

Describe the normal metabolism of alcohol.

Answer 2

Alcohol is metabolised to acetaldehyde in hepatocytes by 3 pathways.

1. Alcohol dehydrogenase in the cytosol
2. Cytochrome P450
3. Catalase enzymes in peroxisomes

Question 3

Describe the pathophysiology of fatty liver.

Answer 3

1. When alcohol dehydrogenase metabolises alcohol to acetaldehyde, NAD+ is converted to NADH.
2. Decreased NAD+ causes decreased fatty acid oxidation and increased NADH causes increased FA production.
3. The overall effect of this is increased fat production in the liver. This is fatty liver or steatosis. The liver is greasy, tender, enlarged and heavy.

Question 4

Describe the pathophysiology of alcoholic hepatitis.

Answer 4

1. Acetaldehyde binds to cell membranes, macromolecules and enzymes. This inhibits them, and forms compounds recognised by the immune system as foreign.
2. Neutrophils migrate to the site and destroy hepatocytes.
3. Alcohol metabolism causes ROS to be produced, which react with proteins and DNA, causing cell damage. (not inflammation tho?)

Question 5

Give 3 symptoms of alcoholic hepatitis.

Answer 5

Malaise
Anorexia
Diarrhoea
Vomiting
Pain (from hepatomegaly)

Question 6

Give 3 signs of alcoholic hepatitis.

Answer 6

Bleeding, ascites, jaundice.

Question 7

How is alcoholic hepatitis diagnosed?

Answer 7

Blood: leukocytosis, thrombocytopaenia, raised INR
LFTs: Raised GGT, ALT, AST, ALP.
Histology: Mallory bodies (damaged intermediate filaments in the cytoplasm of hepatocytes)

Question 8

Give 2 complications of alcoholic liver disease.

Answer 8

Cirrhosis

Liver failure

Question 9

Describe the management of alcoholic liver disease.

Answer 9

1. Close monitoring, screen for infections.
2. Give up alcohol. Withdrawal symptoms - chlordiazepoxode.
3. Optimise nutrition, give thiamine to treat malnutrition from alcohol.
   Corticosteroids may help in severe disease.

Question 10

What are signs of severe hepatitis?

Answer 10

Jaundice, encephalopathy, coagulopathy