Alcoholic Liver Disease Flashcards
Compound responsible for many of the systemic effects of alcohol
Acetaldehyde
Compound postulated to play an etiologic role in alcoholic liver disease
Acetaldehyde
The following contains ~12 g of alcohol
1 bottle of beer
4 ounces of wine
One ounce of 80% spirits
Threshold for developing alcoholic liver disease
men : >60-80 g/day alcohol x 10 years
Women: >20-40 g/day alcohol x 10 years
Abstinence of ___ week reverses simple uncomplicated fatty liver
4-6 weeks
Manifestations of alcohol liver disease
Fatty liver
Alcoholic hepatitis
Alcoholic cirrhosis
Symptoms and signs of
Fatty liver
RUQ pain
Nausea
Fatigue
Hepatomegaly
Most common physical finding in fatty liver
Hepatomegaly
Signs and symptoms of alcoholic hepatitis
Fever
Spider nevi
Jaundice
And abdominal pain
Portal hypertension, ascites, or variceal bleeding can occur in the absence of cirrhosis
Alcoholic cirrhosis signs and symptoms
Constitutional
RUQ pain Fever Nausea and vomiting Diarrhea Anorexia Malaise
More specific complications of alcoholic cirrhosis
More specific - ascites, edema, upper gastrointestinal hemorrhage
PE of alcoholic cirrhosis
Jaundice
Encephalopathy
Hepatomegaly
Splenomegaly
Scleral icterus Palmar erythema Spider angiomas Parotid gland enlargement Digital clubbing Muscle wasting Edema and ascities Males: hyperestrogenemia - decreased body hair, testicular atrophy, gynecomastia
Lab findings in fatty liver or alcoholic hepatitis
AST or ALT increased to 2-7 fold AST/ALT ratio >1 Bilirubin- may be increased Alk phos- modest elevation PMN >5500/uL predicts severe alcoholic hepatitis when discriminant function > 32
Lab findings in alcoholic cirrhosis
Hypoalbuminemia Prolonged PT Increased bilirubin Anemia Thrombocytopenia Imaging : nodular liver , splenomegaly and venous collaterals
Cornerstone in the management of alcoholic liver disease
Complete abstinence from alcohol
Screening tools for alcohol abuse
AUDIT-C
CAGE
MAST
FDA approved medications for alcohol dependence
Disulfiram
Acamprosate
Naltrexone
Goal of alcohol abuse intervention should be
Sustained abstinence
Nutritional support for alcohol hepatitis
Protein 1.2-.5 g/kg
Recommended caloric intake 2500 kcal/ day via oral or NGT feeding
Nightime snack and mornig feeding to improve nitrogen balance
What treatments are indicated for patients with hepatic encephalopathy or at least one of the following:
- Discriminant function>/= 32
- MELD >/= 18
- Glasgow scoe >/=9
Glucocorticoids TNF inhibitor (pentoxifylline)
Contraindications for glucocorticoids for treatment of alcoholic hepatitis
Active GI bleeding
Systemic infections
Renal insufficiency
How to give glucocorticoids for alcoholic hepatitis
Prednisone 40 mg or prednisolone 32 mg daily for 7 days
If serum bilirubin decreases, continue for an additional 21 days, followed by 2 week taper
For alcoholic hepatitis patients with active GI bleeding, systemic infection, renal insufficiency
TNF inhibitor ( Pentoxifylline)
How is TNF inhibito given
Pentoxifyline 400 mg TID for 28 days
Is the second most common indication for liver transplantation
Alcoholic cirrhosis
