Alcoholic liver disease

Question 1

What investigations are required for alcoholic liver disease?

Answer 1

Bloods - FBC, U and E, LFT including INR, hepatitis serology and full liver screen eventually including autoantibodies
Liver ultrasound to look for obstructive cause of jaundice and portal hypertension
Diagnostic ascitic tap - risk of SBP

Question 2

Why does alcoholism cause low platelets?

Answer 2

Portal hypertension with hypersplenism takes platelets out of the blood
Direct toxic effect of alcohol on the bone marrow reduces platelet production

Question 3

What are the two main things to treat in the first 24 hours with alcoholic liver disease?

Answer 3

Alcohol withdrawl - first-line: benzodiazepines e.g. chlordiazepoxide. Typically given as part of a reducing dose protocol
Identifying why the liver has decompensated and treating- infection, GI bleed, drugs

Question 4

What is the mechanism behind alcohol withdrawl symptoms?

Answer 4

Chronic alcohol use results in increased GABA inhibition of the CNS
When drinking stops it has the opposite effect and leads to an overactivity from reduced GABA inhibition

Question 5

What is the most imporatant advice following treatment of alcoholic liver disease in hospital?

Answer 5

Abstinence from alcohol