Alcoholic Liver Disease

Question 1

What issues can alcohol lead to?

Answer 1

• Alcoholic Liver Disease

- Alcohol Dependance

Question 2

What is the stepwise progression of alcoholic liver disease?

Answer 2

1- Alcohol related fatty liver

2- Alcoholic hepatitis

3- Cirrhosis

Question 3

How does alcoholic fatty liver resolve?

Answer 3

Self-resolves in 2 weeks with no alcohol

Question 4

Can alcoholic hepatitis resolve?

Answer 4

If mild and permanent abstinence

Question 5

How does cirrhosis occur?

Answer 5

Liver becomes irreversibly scarred

Question 6

How can cirrhosis progression be slowed?

Answer 6

Stop drinking to prevent further damage

Question 7

What is the recommended alcohol intake?

Answer 7

14u men and women

Spread over 3+ days

Question 8

What cancers does drinking particularly predispose to?

Answer 8

• Breast
• Mouth
• Throat

Question 9

Who should avoid alcohol?

Answer 9

Pregnant women

Question 10

How can alcohol intake be assessed?

Answer 10

• CAGE

- AUDIT (WHO questionnaire)

Question 11

Outline the CAGE questionnaire.

Answer 11

Cut down (thought you should)

Annoyed (when people comment)

Guilty (about drinking)

Eye opener (drink when you wake up/help hangover)

Question 12

What score on the audit questionnaire indicates harmful alcohol use?

Answer 12

8

Question 13

What are the complications of alcoholism?

Answer 13

• Alcoholic liver disease
• Cirrhosis
• Dependence
• Wernicke-Korsakoff Syndrome
• Pancreatitis

Question 14

What are the signs of chronic liver disease?

Hands round to Abdomen

Answer 14

• Palmar erythema
• Asterixis
• Bruising (abnormal clotting)
• Jaundice
• Spider Naevi
• Gynaecomastia
• Ascites
• Caput Medusa
• Hepatomegaly
• Testicle atrophy

Question 15

What bloods should be done in suspected liver disease?

Answer 15

FBC

LFTs

UsEs

Clotting Studies

Question 16

What might an FBC show in alcoholic liver disease?

Answer 16

Raised MCV

Question 17

What might an LFTs show in alcoholic liver disease?

Answer 17

• Raised ALT/AST
• Raised GGT
• Low albumin
• Raised bilirubin

Question 18

What can cause raised GGT?

Answer 18

• Alcohol
• Pregnancy
• Obstruction

Question 19

Why might albumin be low in alcoholic liver disease?

Answer 19

Reduced synthetic function of the liver

Question 20

What might UsEs show in alcoholic liver disease?

Answer 20

Ur and Cr deranged in hepatorenal syndrome

Question 21

What might clotting studies show in alcoholic liver disease?

Answer 21

Prolonged clotting time

Question 22

Why might clotting be prolonged in liver disease?

Answer 22

Liver produces clotting factors

Question 23

Which clotting factors does the liver produce?

Answer 23

5
7
9-12

Question 24

What imaging is useful in liver disease?

Answer 24

USS

FibroScan

CT and MRI

Question 25

What will USS of the liver show?

Answer 25

Fatty changes- ‘echogenicity’

Question 26

What is FibroScan?

Answer 26

Transient Elastography

Question 27

What does a FibroScan show?

Answer 27

Elasticity of the liver- reduced in cirrhosis

Question 28

How often should FibroScan be done in people at risk of Cirrhosis?

Answer 28

Every 2 Years | or yearly if Hep B

Question 29

What might CT/MRI show in liver disease?

Answer 29

Fatty infiltration

Question 30

What orifice test is used in liver disease?

Answer 30

OGD

Question 31

What may an OGD show in decompensated liver disease?

Answer 31

Varices

Question 32

How can diagnosis be confirmed in alcoholic liver disease?

Answer 32

Biopsy

Question 33

When else should liver biopsy be used?

Answer 33

Whenever long term steroids are started

Question 34

What is the conservative management of alcoholic liver disease?

Answer 34

- Alcohol abstinence and detox - Nutritional support- Thiamine and high protein diet - Education and possibly MDT

Question 35

What can improve outcomes in alcoholic hepatitis?

Answer 35

Steroids (only effective for up to 3/12)

Question 36

How can alcohol withdrawal be assessed?

Answer 36

CIWA | clinical institute withdrawal assessment

Question 37

What is given to prevent alcohol withdrawal?

Answer 37

Chlordiazepoxide | Diazepam less commonly

Question 38

What is chlordiazepoxide?

Answer 38

Benzodiazepine

Question 39

How is chlordiazepoxide used?

Answer 39

Titrated down over 5-7 days

Question 40

What else should alcoholics be given?

Answer 40

- IV B vitamins (Pabrinex) | - PO Thiamine after this

Question 41

Which vitamin is Thiamine?

Answer 41

B1

Question 42

What withdrawal symptoms occur between 6-12 hours?

Answer 42

SHAT - Sweating - Headache - Anxiety - Tremor

Question 43

What withdrawal symptoms occur between 12-24 hours?

Answer 43

Hallucinations

Question 44

What withdrawal symptoms occur between 24-48 hours?

Answer 44

Seizures

Question 45

What withdrawal symptoms occur between 24-72 hours?

Answer 45

Delirium Tremens

Question 46

What is delirium tremens?

Answer 46

Medical emergency due to alcohol withdrawal - GABA under-functions and Glutamate over-functions - Brain very excitable due to excessive adrenergic activity

Question 47

How does Delirium Tremens present?

Answer 47

- Confusion - Hallucinations - Tremor - Tachycardia and arrhythmia - HTN - Hyperthermia - Ataxia

Question 48

What is the mortality of untreated delirium tremens?

Answer 48

35%

Question 49

What causes Wernicke-Korsakoff Syndrome?

Answer 49

Low Thiamine

Question 50

What vitamin is thiamine?

Answer 50

B1

Question 51

How does Wernicke’s Encephalopathy present?

Answer 51

- Confusion - Oculomotor disturbances - Ataxia (poor coordination)

Question 52

How does Korsakoff’s Syndrome appear clinically?

Answer 52

- Memory impairment | - Behavioural changes

Question 53

What may Korsakoff’s Syndrome mimic?

Answer 53

Dementia

Question 54

For how long must you stop drinking to be eligible for a liver transplant?

Answer 54

3 months