Alcoholic liver disease

Question 1

What is alcohol liver disease?

Answer 1

Chronic liver disease caused by excess of alcohol

Question 2

Clinical presentation of alcoholic liver disease

Answer 2

Fatty liver = usually no symptoms
Possible hepatomegaly on examination
Alcohol hepatitis = rapid onset, jaundice
Nausea, anorexia, encephalopathy, fever and ascites.
Alcohol cirrhosis: May be asymptomatic
Usually present with complications of cirrhosis.
Spider naevi are a classic

Question 3

What is Spider naevi

Answer 3

Collection of small, dilated arterioles (blood vessels) clustered very close to the surface of the skin. The cluster of vessels is web-like, with a central spot and radiating vessels.

Question 4

What 3 pathological lesions associate with progression into alcoholic liver disease

Answer 4

Fatty liver
Hepatitis
Cirrhosis

Question 5

Pathophysiology of alcoholic liver disease

Answer 5

Fatty liver (steatosis) - biopsy finding
Hepatocytes contain macro vesicular droplets of triglycerides.
Fat disappears on cessation of alcohol intake, but otherwise may progress to fibrosis and cirrhosis. Possibly as a result of mitochondrial damage.
Foamy degeneration of hepatocytes also possible.
*Alcoholic hepatitis - ballooned hepatocytes that contain eosinophilic material called Mallory bodies, surrounded by neutrophils.
Regenerating nodules bring micro nodular cirrhosis.

Question 6

Aetiology of alcoholic liver disease

Answer 6

Excessive consumption of alcohol
Exact mechanism is unknown, beyond identifying alcohol as a Hepatoxin.
Some genetic predisposition

Question 7

Epidemiology of alcoholic liver disease

Answer 7

Most common cause of chronic liver disease in western world.

Usually presents in men in 40-50s

Question 8

Diagnosis of alcoholic liver disease

Answer 8

Liver biochemistry - AST and ALT rise (disproportionately AST)
Bloods - Elevated MCV

Question 9

Treatment of alcoholic liver disease

Answer 9

Lifelong abstinence from alcohol
Corticosteroids to control inflammation if there’s no renal failure
Treat malnutrition from alcohol - thiamine

Question 10

Complications of alcoholic liver disease if untreated

Answer 10

Liver failure

Question 11

How does alcoholic liver disease eventually lead to cirrhosis

Answer 11

Reduced NAD+ -> less oxidation of fat -> accumulation of fat in hepatocytes
Increased ROS damages hepatocytes
Acetaldehyde damages liver cell membranes
This leads to inflammation and eventual cirrhosis

Question 12

Describe what is seen on liver function tests

Answer 12

GGT very raised

AST, ALT mildly raised (increased AST>ALT ratio)

Question 13

What type of anaemia is seen in alcoholic liver disease

Answer 13

Macrocytic anaemia

Question 14

Possible co-existing diseases due to alcohol

Answer 14

Acute/chronic pancreatitis
Mallory-Weiss tear
Alcohol withdrawal – delirium tremens

Question 15

What is the final stage of alcoholic liver disease

Answer 15

Cirrhosis (and probs liver failure?)

Question 16

What do ALT, AST and GGT stand for?

Answer 16

ALT = Alanine transaminase
AST = Aspartate transaminase
GGT = Gamma-glutamyltransferase