Alcoholic Liver Disease

Question 1

2 factors altering effect of alcohol on alimentary system & liver

Answer 1

Genetic variation

Women metabolise slower than men

Question 2

What is steatosis?

Answer 2

Fatty liver

Question 3

What is steatohepatitis?

Answer 3

Fatty liver with inflammation

Question 4

What is involved in an alcohol history? (4)

Answer 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?

Question 5

2 tools to assess alcohol history?

Answer 5

CAGE

FAST score - audit questions

Question 6

8 physical findings in alcoholic liver disease?

Answer 6

Spider naevi
Palmer erythema
Gynaecomastia
Loss of axillary & pubic hair
Ascites
Encephalopathy
Jaundice
Muscle Wasting - bad nutrition

Question 7

When do physical findings usually present in liver disease?

Answer 7

When it is advanced

Question 8

What is encephalopathy?

Answer 8

Brain disease, damage or malfunction

Question 9

When does hepatic encephalopathy present?

Answer 9

Liver failure

Question 10

How is hepatic encephalopathy graded?

Answer 10

1-4 (1= mild confusion, 4 = coma)

Question 11

What are the 5 causes of hepatic encephalopathy?

Answer 11

Infection
Drugs
Constipation
GI bleed
Electrolyte Disturbance

Question 12

What 3 things need to be excluded in suspected hepatic encephalopathy?

Answer 12

Infection
Hypoglycaemia
Intracranial bleed

Question 13

What is the treatment of hepatic encephalopathy? (3)

Answer 13

Bowel clear out
Antibiotics
Supportive - ITU (airway, nasogastric)

Question 14

How are the bowel cleared out in hepatic encephalopathy? (2)

Answer 14

Lactulose

Enema

Question 15

What would lab results show in liver disease? (4)

Answer 15

AAT > ALT (Ratio >2)
Raised Gamma Glutamyl Transferase
Macrocytosis
Thrombocytopenia

Question 16

What is macrocytosis?

Answer 16

Enlargement of red blood cells

Question 17

What is Thrombocytopenia?

Answer 17

Low blood platelets

Question 18

Presentation of spontaneous bacterial peritonitis? (6)

Answer 18

Abdo pain
Fever
Rigors
Renal impairment
Sepsis
Tachycardia

Question 19

Treatment of spontaneous bacterial peritonitis? (3)

Answer 19

IV antibiotics
Ascitic fluid drainage
IV albumin injection (20% ALBA)

Question 20

What is the cause of alcoholic hepatitis?

Answer 20

Alcohol

Question 21

What is alcoholic hepatitis?

Answer 21

Inflammation of the liver due to drinking alcohol

Question 22

4 symptoms of alcoholic hepatitis?

Answer 22

Loss of appetite
Nausea & vomiting
Fatigue & weakness
Weightloss

Question 23

4 signs of alcoholic hepatitis?

Answer 23

Jaundice
Encephalopathy
Infection common
Abdominal tenderness

Question 24

What would be found on diagnostic tests in ALD? (5)

Answer 24

Low albumin
Raised prothrombin time
Raised bilirubin
Raised GGT
Raised AlkP

Question 25

5 investigations of ALD?

Answer 25

Blood tests/LFTs
Ultrasound
CT
MRI
Liver biopsy

Question 26

Treatment for ALD?

Answer 26

Alcohol cessation
Treat infection
Treat encephalopathy
Treat alcohol withdrawal
Protect against GI bleed
Steroids
Nutrition (NG tube)

Question 27

What is essential in nutritional support?

Answer 27

Thiamine

Question 28

What is thiamine?

Answer 28

Vitamin B1

Question 29

How are steroids prescribed for ALD?

Answer 29

According to Glasgow Alcoholic Hepatitis Score

Question 30

How is the prognosis of ALD?

Answer 30

Poor