Alcoholic Liver Disease

Question 1

What are the stages of alcoholic liver disease?

Answer 1

Fatty liver
Alcoholic Hepatitis
Cirrhosis

Question 2

What is fatty liver?

Answer 2

Metabolism of alcohol produces fat in the liver

Reversible on stoppage of alcohol

Question 3

What is alcoholic hepatitis?

Answer 3

Inflammation of the liver caused by alcohol

Infiltration by leucocytes and hepatocyte necrosis

Question 4

What is the histopathology of alcoholic cirrhosis?

Answer 4

Micronodular fibrosis of liver with fatty change

Question 5

Clinical features of alcoholic liver disease

Answer 5

Some are asymptomatic

History of excessive alcohol use
Mild jaundice 
Abdominal pain 
Fever
Hepatomegaly
Nausea
Ascites

Question 6

Investigations for alcoholic liver disease

Answer 6

Bloods

• LFTs (raised bilirubin, AST, ALT, ALP)
• FBCs (leucocytosis)
• Gamma GT

Ultrasound - fatty infiltration

Question 7

Management of alcoholic liver disease

Answer 7

Alcohol cessation
Thiamine IV - prevent encephalopathy
Steroids (use Maddrey score)

Question 8

What is the maddrey score

Answer 8

Evaluates severity and prognosis in alcoholic hepatitis

4.6 x (prothrombin time / control) + bilirubin

> 32 = would be helped by steroids

Question 9

What is the the glasgow score?

Answer 9

Calculates percent mortality dependent on score

Age
WCC
Urea
Bilirubin 
INR

Poor prognosis >9