Alcoholic Liver Disease Flashcards
What age group is ALD most present in?
45-64
What would be a common presentation of liver/biliary problems?
- Drinks a bottle of wine a night (9 units)
- Painless jaundice for 2 weeks
- Weight loss 6 weeks
What investigations would you do for someone presenting with liver/biliary problems?
- Bilirubin (BR)
- Alk phos
- ALT
- Albumin
- CT scan
What would the LFTs and albumin results be like?
- High BR
- V high alk phos
- High ALT
- Low albumin
What is alkaline phosphatase?
Biliary enzyme, high = sign of cholestasis
What tubes are there in the liver?
- Biliary tree
- Portal system
- Hepatic veins and arteries
What do thick black lines in the liver suggest on a CT?
- Very prominent bile ducts
- Suggests something has blocked the bile ducts
What else on the CT would suggest biliary obstruction?
Large and wide common bile duct (2cm wide)
What can be put in the bile duct to relieve jaundice?
A metal stent
What do the high LFTs, low albumin and enlarged bile ducts suggest?
High grade Hodgkin B cell lymphoma of diffuse large B cells type
How might someone with ALD present?
- Heavy drinker
- Painless jaundice 3 weeks
- Swollen abdomen over last month
- Spider naevi
- Dupytren’s contractures
What investigations would you do for ALD?
- BR
- ALT
- Alk phos
- Albumin
- INR
Why do you measure INR in liver disease?
One main job of the liver is to create vitamin K clotting factors, so if not working, INR increases
What is normal INR?
1-1.3
What investigation results would you get for someone with ALD?
- V high BR
- High alk phos
- V high ALT
- V low Albumin
- High INR (2.1)
What group of people might just have spider naevi normally?
Women
What are spider naevi due to?
Chronic liver disease - oestrogen is not broken down as it should be, leading to vascular effects
What is Dupytren’s contracture due to?
Thickened fascia
What are two key features of acute on chronic liver disease/decompensated chronic liver disease?
1) Jaundice
2) Ascites (due to portal HTN and cirrhosis)
Why might someone with ALD have scoriations?
Jaundice is itchy
What is the Child-Pugh classification of cirrhosis?
A measure of the degree of decompensation
What score on Child-Pugh is grade C and high?
> 10 (max 15)
What should you assume in someone with ALD?
That they have vitamin deficiencies esp. thiamine
What do you do in order to not miss other causes of liver disease?
A liver screen
What does a liver screen consist of?
- Abdominal ultrasound
- Autoimmune screen
- Caeruloplasmin (< 40 years)
- Alpha-1 antitrypsin
- Transferrin saturation
- Hepatitis
What would a biopsy in someone with ALD show?
- Acute inflammation
- Background fibrosis (alcohol related)
- Infiltrated neutrophils
- Fat in hepatocytes
- Hyaline deposition
What is used to calm down acute inflammation in decompensated ALD?
Prednisolone 40mg OD
What is ‘alcoholic hepatitis’?
Toxic inflammation
What are oesophageal varices?
Swollen veins bc of portal hypertension
What is done to treat oesophageal varices?
- Bleeding is stopped by tying off the varices with an elastic band
- Can cause dysphagia
What can happen in the chest due to acute liver disease?
- Hepatic hydrothorax = massive pleural effusion (water in thoracic cavity)
- Ascites goes to lungs
- Respiratory failure
What can ALD cause in the brain?
Encephalopathy
Why might someone with liver failure have anaemia?
Due to bone marrow problems
When can someone get a liver transplant with ALD?
No alcohol for 6 months
What is the most severe liver failure?
Acute on chronic liver failure
What are complications of decompensation?
Bleeding, encephalopathy, hydrothorax
What type of cancer typically presents with painless jaundice?
Pancreatic cancer
What condition would present with ureteric colic, pain and jaundice?
Stones
