Alcoholic Liver Disease Flashcards
2 factors altering effect of alcohol on alimentary system & liver
Genetic variation
Women metabolise slower than men
What is steatosis?
Fatty liver
What is steatohepatitis?
Fatty liver with inflammation
What is involved in an alcohol history? (4)
CAGE
- Have you ever felt the need to CUT DOWN?
- Have you ever been ANNOYED by criticism of your drinking?
- Have you ever felt GUILTY about your drinking?
- Do you need an EYEOPENER?
2 tools to assess alcohol history?
CAGE
FAST score - audit questions
8 physical findings in alcoholic liver disease?
Spider naevi Palmer erythema Gynaecomastia Loss of axillary & pubic hair Ascites Encephalopathy Jaundice Muscle Wasting - bad nutrition
When do physical findings usually present in liver disease?
When it is advanced
What is encephalopathy?
Brain disease, damage or malfunction
When does hepatic encephalopathy present?
Liver failure
How is hepatic encephalopathy graded?
1-4 (1= mild confusion, 4 = coma)
What are the 5 causes of hepatic encephalopathy?
Infection Drugs Constipation GI bleed Electrolyte Disturbance
What 3 things need to be excluded in suspected hepatic encephalopathy?
Infection
Hypoglycaemia
Intracranial bleed
What is the treatment of hepatic encephalopathy? (3)
Bowel clear out
Antibiotics
Supportive - ITU (airway, nasogastric)
How are the bowel cleared out in hepatic encephalopathy? (2)
Lactulose
Enema
What would lab results show in liver disease? (4)
AAT > ALT (Ratio >2)
Raised Gamma Glutamyl Transferase
Macrocytosis
Thrombocytopenia
What is macrocytosis?
Enlargement of red blood cells
What is Thrombocytopenia?
Low blood platelets
Presentation of spontaneous bacterial peritonitis? (6)
Abdo pain Fever Rigors Renal impairment Sepsis Tachycardia
Treatment of spontaneous bacterial peritonitis? (3)
IV antibiotics
Ascitic fluid drainage
IV albumin injection (20% ALBA)
What is the cause of alcoholic hepatitis?
Alcohol
What is alcoholic hepatitis?
Inflammation of the liver due to drinking alcohol
4 symptoms of alcoholic hepatitis?
Loss of appetite
Nausea & vomiting
Fatigue & weakness
Weightloss
4 signs of alcoholic hepatitis?
Jaundice
Encephalopathy
Infection common
Abdominal tenderness
What would be found on diagnostic tests in ALD? (5)
Low albumin Raised prothrombin time Raised bilirubin Raised GGT Raised AlkP
5 investigations of ALD?
Blood tests/LFTs Ultrasound CT MRI Liver biopsy
Treatment for ALD?
Alcohol cessation Treat infection Treat encephalopathy Treat alcohol withdrawal Protect against GI bleed Steroids Nutrition (NG tube)
What is essential in nutritional support?
Thiamine
What is thiamine?
Vitamin B1
How are steroids prescribed for ALD?
According to Glasgow Alcoholic Hepatitis Score
How is the prognosis of ALD?
Poor
