Alcoholic Liver Disease Flashcards
Is alcoholic liver damage reversible?
Yes if alcohol related fatty liver or alcoholic mild hapatitis still
Cirrhosis not
What is the questionnaire used to identify problem drinking?
CAGE Cut down Angry Guilty Eye Opener
What is the WHO tool to screen for drinking?
AUDIT tool
>8 is harmful
What are signs and symptoms of alcohol induced liver injury
- Jaundice
- Hepatomegaly
- Spider Naevi
- Palmar erythema
- Gynaecomastia
- Ascites
- Easy bruising
- Caput Medusae- Engorged epigastric superficial veins
- Asterixis- flapping tremor
What LFTs are seen in alcoholic liver diseae
Raised ALT, AST, GGT, Billi
low Alb
Elevated PTT
Deranged Us and Es
What investigations are done in alcoholic liver disease?
Fibroscan
Endoscopy for varices
CT/MRI for HCC, hepatomegaly /ascites
Biopsy to confirm diagnosis recommended before starting steroid therapy
How is alcoholic liver disease managed?
Stop drinking
Nutrition- THIAMINE and high protein
Steroids improve short term outcomes if severe but only used if no bleeding risk and no infection
Treat complications of cirrhosis
Refer for transplant after 3 months of abstinence
What symptoms are seen 6-12 hours after withdrawal from alc?
Tremor Sweat Headache Cravings Anxiety
What is seen 12-24 hours after alc withdrawal?
Hallucinations
What is seen 24-48 hours after alc withdrawal?
Seizures
WHat is seen 24-72 hours after alc withdrawal?
Delirium Tremens
What are symptoms of delirium tremens?
- Confusion
- Agitation
- Tremor
- Tachycardia
- Hypertension
- Hyperthermia
- Ataxia
- Arrhythmias
What causes delirium tremens?
Upregulation of GABA and downregulation of glutamate with chronic alc use, so withdrawal causes teh opposite.
Brain exciteability and excess adrenergic activity.
How is delirium tremens managed?
Medical emergency with high mortality
CHLORDIAZEPOXIDE orally for 5-7 days
Pabrinex (Thiamine) IV then orally
What is Wernicke’s?
Confusion
Oculomotor disturbance
Ataxia
Reversible
