Alcoholic Liver Disease

Question 1

Pathophysiology?

Answer 1

1. fatty liver (steatosis)
2. fibrosis
3. cirrhosis

Question 2

aetiology?

Answer 2

long-term excessive drinking + genetic predisposition

Question 3

Screening tool?

Answer 3

C- have you ever felt the need to cut down?

A- do you get annoyed by other people criticising your drinking?

G-do you feel guilty about drinking?

E- do you ever drink first thing in the morning?

Question 4

what score on CAGE screening tool is clinically significant?

Answer 4

score > 2

Question 5

presentation?

Answer 5

• jaundice
• HSM
• portal HT
  
  • varices: oesophageal, caput medusae
• ascites
• asterixis
• spider naevi
• palmar erythema
• gynaecomastia
• bruising

Question 6

Ix?

Answer 6

• CAGE / AUDIT screening tool
• Bloods
  
  • FBC–> macrocytic anaemia
  • LFTs–> raised GGT and aminotransferases. ALP later in disease
  • ALbumin –> low
  • PT–> raised
  • Billirubin–> raised if cirrhosis
  • U&E may be deranged in hepatorenal syndrome
• US
• FibroScan- helps assess degree of cirrhosis
• CT/MRI
• Endoscopy - varices, when portal HT is suspected
• Liver biopsy

Question 7

Mx?

Answer 7

abstinence, nutritional support w/ vitamins, treat complications of cirrhosis, liver transplant

Question 8

complications?

Answer 8

• complications of cirrhosis –> portal HT, varices, ascites & hepatic encephalopathy
• Wernicke-korsakoff syndrome
• pancreatitis
• alcoholic cardiomyopathy