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Yr2 GI Joe > Alcoholic liver disease > Flashcards

Alcoholic liver disease Flashcards

1
Q

Why does alcohol damage the liver?

A
  • Alcohol is directly toxic to the liver (especially with chronic exposure)
  • Alcohol interrupts/affects many metabollic pathways like gluconeogenesis and lipid metabolism
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2
Q

What are the pathways for ethanol metabolism?

A

Oxidative:

Ethanol –> Acetaldehyde –> Acetate

Done by Dehydrogenase enzymes

Microsomal enzyme oxidation system:

Ethanol –> Acetaldehyde

Done by Cytochrome P45…

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3
Q

What is steatosis and how does alcohol cause it?

A

Steatosis means fatty liver

Fat builds up as alcohol interrupts the lipid metabolic pathway so it accumulates

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4
Q

What is steatohepatitis?

What is the long term effect on the liver?

A

Fatty liver with inflammation (neutrophilic infiltration)

Inflammation causes fibrosis. The scar tissue builds up and the liver becomes cirrhotic.

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5
Q

What are signs of chronic liver disease?

A

Ascites (distended abdomen)

Jaundice

Muscle wasting

Spider naevi

Gynaecomastia

Palmar erythema

Loss of axillar, pubic and chest hair

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6
Q

What lab tests will show alcohlic damage to the liver?

A

Raised AST:ALT ratio (>2)*

Raised Gamma Glutamyl Transferase (GGT)

Macrocytosis (enlarged RBCs)

Thrombocytopenia (low platelets)

Aspartate aminotransferase (AST)*

Alanine transaminase (ALT)

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7
Q

What imaging modality is best for showing fatty liver?

A

Ultrasound scan

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8
Q

What is hepatic encephalopathy?

A

Syndrome characterised by a spectrum of neuropsychiatric abnormalities in patients with liver dysfunction/failure, after exclusion of brain disease

It happens when there is a rise in ammonia levels in the body, but the damaged liver cannot manage it

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9
Q

How is hepatic encephalopathy graded?

A

Graded 1-4:

1 - milnd confusion

4 - coma

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10
Q

What are the causes of hepatic encephalopathy?

(ie causes of raised ammonia levels)

A

Infection

Drugs

Constipation

GI bleed

Electrolyte disturbance

(in someone with a shitty liver)

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11
Q

Hepatic encephalopathy is diagnosed through ruling out other conditions such as neurological ones which cause the symptoms.

What causes/problems must be ruled out?

A

Infection

Hypoglycaemia

Intracranial bleed

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12
Q

How is hepatic encephalopathy treated?

A

Treat cause…

Bowel clear out, Lactulose (laxative), Enemas

Antibiotics

Supportive management:

  • ITU
  • Airway support
  • Nasogastric tube for meds
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13
Q

What is lactulose?

A

A laxative

Given rectally in hepatic encephalopathy

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14
Q

Symptoms for spontaneous bacterial peritonitis?

A

Abdominal pain

Fever

Rigors (shivering/feeling cold)

N&V (sepsis)

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15
Q

What are the signs of spontaneous bacterial peritonitis?

A

Ascites

Sepsis - malaise, N&Vs etc

Tachycardia

Pyrexia

Signs of renal impairment

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16
Q

How is spontaneous bacterial peritonitis investigated?

A

Ascitic tap procedure (peritonocentesis)

  • fluid protein & glucose levels
  • cultures
  • cell count (SBP –> neutrophilia)

This is a type of paracentesis when ascites fluid is drained from the peritoneum. It can be used to investigate (samples) and to fully drain the fluid.

17
Q

What is done with the fluid sample taken in an ascitic tap procedure?

(give values needed for diagnosis)

A

Protein levels <25g/L

Glucose levels

Cultures - typically E.coli

White cell content - Neutrophil count >0.25x109 /L

18
Q

What must be excluded to diagnose spontaneous bacterial peritonitis?

A

Surgical causes must be excluded

19
Q

How is spontaneous bacterial peritonitis be treated?

A
  • IV antibiotics
  • Ascitic fluid drainage (ascitic tap)
  • +/- IV albumin infusion (20% ALBA) - holds fluid in the vasculature so ascites doesnt refill after drainage
20
Q

What is alcoholic hepatitis and how does it present?

A

Inflammation of the liver due to excess alcohol intake. Often associated with steatosis/steatohepatitis.

It can cause cirrhosis, presenting with:

Jaundice

Encephalopathy

Infection common

Decompensated hepatic function

21
Q

What measurements indicate decompensated hepatic function?

A

Low albumin

Raised prothrombin time (aka INR)

22
Q

What does prothrombin time actually mean?

A

Basically how long the blood takes to clot

23
Q

How is a diagnosis of Alcoholic hepatitis made?

A
  • low albumin
  • raised INR (prothrombin)
  • raised bilirubin
  • raised GGT & ALP
  • history of excess alcohol
  • exclusion through imaging of cancer or other causes
24
Q

What is the prognosis for alcoholic hepatitis?

A

40% mortality

In severe cases, 90% mortality

Also higher if patient:

  • Continues drinking alcohol
  • Presented with encephalopathy
25
Q

How is alcoholic hepatitis treated?

A

Supportive

Steroids (if severe)

Treat infection

Treat encephalopathy

Treat alcohol withdrawal

Protect against GI bleeding

Airway Protection / ITU care

26
Q

How severe must alcoholic hepatitis be before treatment with steroids is indicated?

A

Glasgow Alcoholic Hepatitis Score >9

or

Maddrey’s discriminant function >32

27
Q

What is Maddreys discriminant function?

A

Maddrey discriminant function (DF) is the traditional model for evaluating the severity and prognosis in alcoholic hepatitis and evaluates the efficacy of using alcoholic hepatitis steroid treatment

28
Q

What nutritional management is given to people with alcoholic hepatitis?

A

High energy/calorie intake

High thiamine intake

Frequent feeds

+/- Consultation with dietician

29
Q

How many people in the population have a ‘fatty liver’?

A

25-40%

30
Q

What are risk factors/causes of fatty liver development?

A

Obesity

Diabetes

Hypercholesterolaemia

High alcohol intake

31
Q

Steatohepatitis (fat + inflammation) is histologically similar to what?

A

Liver damaged by alcohol

32
Q

‘A 1/4 of patients with steatohepatitis will develop ______’

A

Liver cirrhosis

33
Q

What are the symptoms of Steatohepatitis?

A

Asymptomatic

34
Q

What signs/investigations show steatohepatitis?

A

Raised Alanine amino transferase

Fatty liver on USS

Liver Biopsy

35
Q

How is steatohepatitis treated?

A

Weight loss

Exercise

Yr2 GI Joe (28 decks)

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