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Junior Medicine- GI > Alcoholic Liver Disease > Flashcards

Alcoholic Liver Disease Flashcards

1
Q

What issues can alcohol lead to?

A
  • Alcoholic Liver Disease

- Alcohol Dependance

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2
Q

What is the stepwise progression of alcoholic liver disease?

A

1- Alcohol related fatty liver

2- Alcoholic hepatitis

3- Cirrhosis

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3
Q

How does alcoholic fatty liver resolve?

A

Self-resolves in 2 weeks with no alcohol

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4
Q

Can alcoholic hepatitis resolve?

A

If mild and permanent abstinence

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5
Q

How does cirrhosis occur?

A

Liver becomes irreversibly scarred

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6
Q

How can cirrhosis progression be slowed?

A

Stop drinking to prevent further damage

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7
Q

What is the recommended alcohol intake?

A

14u men and women

Spread over 3+ days

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8
Q

What cancers does drinking particularly predispose to?

A
  • Breast
  • Mouth
  • Throat
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9
Q

Who should avoid alcohol?

A

Pregnant women

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10
Q

How can alcohol intake be assessed?

A
  • CAGE

- AUDIT (WHO questionnaire)

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11
Q

Outline the CAGE questionnaire.

A

Cut down (thought you should)

Annoyed (when people comment)

Guilty (about drinking)

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

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12
Q

What score on the audit questionnaire indicates harmful alcohol use?

A

8

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13
Q

What are the complications of alcoholism?

A
  • Alcoholic liver disease
  • Cirrhosis
  • Dependence
  • Wernicke-Korsakoff Syndrome
  • Pancreatitis
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14
Q

What are the signs of chronic liver disease?

Hands round to Abdomen

A
  • Palmar erythema
  • Asterixis
  • Bruising (abnormal clotting)
  • Jaundice
  • Spider Naevi
  • Gynaecomastia
  • Ascites
  • Caput Medusa
  • Hepatomegaly
  • Testicle atrophy
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15
Q

What bloods should be done in suspected liver disease?

A

FBC

LFTs

UsEs

Clotting Studies

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16
Q

What might an FBC show in alcoholic liver disease?

A

Raised MCV

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17
Q

What might an LFTs show in alcoholic liver disease?

A
  • Raised ALT/AST
  • Raised GGT
  • Low albumin
  • Raised bilirubin
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18
Q

What can cause raised GGT?

A
  • Alcohol
  • Pregnancy
  • Obstruction
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19
Q

Why might albumin be low in alcoholic liver disease?

A

Reduced synthetic function of the liver

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20
Q

What might UsEs show in alcoholic liver disease?

A

Ur and Cr deranged in hepatorenal syndrome

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21
Q

What might clotting studies show in alcoholic liver disease?

A

Prolonged clotting time

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22
Q

Why might clotting be prolonged in liver disease?

A

Liver produces clotting factors

23
Q

Which clotting factors does the liver produce?

A

5
7
9-12

24
Q

What imaging is useful in liver disease?

A

USS

FibroScan

CT and MRI

25
Q

What will USS of the liver show?

A

Fatty changes- ‘echogenicity’

26
Q

What is FibroScan?

A

Transient Elastography

27
Q

What does a FibroScan show?

A

Elasticity of the liver- reduced in cirrhosis

28
Q

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

A

Every 2 Years

or yearly if Hep B

29
Q

What might CT/MRI show in liver disease?

A

Fatty infiltration

30
Q

What orifice test is used in liver disease?

A

OGD

31
Q

What may an OGD show in decompensated liver disease?

A

Varices

32
Q

How can diagnosis be confirmed in alcoholic liver disease?

A

Biopsy

33
Q

When else should liver biopsy be used?

A

Whenever long term steroids are started

34
Q

What is the conservative management of alcoholic liver disease?

A
  • Alcohol abstinence and detox
  • Nutritional support- Thiamine and high protein diet
  • Education and possibly MDT
35
Q

What can improve outcomes in alcoholic hepatitis?

A

Steroids (only effective for up to 3/12)

36
Q

How can alcohol withdrawal be assessed?

A

CIWA

clinical institute withdrawal assessment

37
Q

What is given to prevent alcohol withdrawal?

A

Chlordiazepoxide

Diazepam less commonly

38
Q

What is chlordiazepoxide?

A

Benzodiazepine

39
Q

How is chlordiazepoxide used?

A

Titrated down over 5-7 days

40
Q

What else should alcoholics be given?

A
  • IV B vitamins (Pabrinex)

- PO Thiamine after this

41
Q

Which vitamin is Thiamine?

A

B1

42
Q

What withdrawal symptoms occur between 6-12 hours?

A

SHAT

  • Sweating
  • Headache
  • Anxiety
  • Tremor
43
Q

What withdrawal symptoms occur between 12-24 hours?

A

Hallucinations

44
Q

What withdrawal symptoms occur between 24-48 hours?

A

Seizures

45
Q

What withdrawal symptoms occur between 24-72 hours?

A

Delirium Tremens

46
Q

What is delirium tremens?

A

Medical emergency due to alcohol withdrawal

  • GABA under-functions and Glutamate over-functions
  • Brain very excitable due to excessive adrenergic activity
47
Q

How does Delirium Tremens present?

A
  • Confusion
  • Hallucinations
  • Tremor
  • Tachycardia and arrhythmia
  • HTN
  • Hyperthermia
  • Ataxia
48
Q

What is the mortality of untreated delirium tremens?

A

35%

49
Q

What causes Wernicke-Korsakoff Syndrome?

A

Low Thiamine

50
Q

What vitamin is thiamine?

A

B1

51
Q

How does Wernicke’s Encephalopathy present?

A
  • Confusion
  • Oculomotor disturbances
  • Ataxia (poor coordination)
52
Q

How does Korsakoff’s Syndrome appear clinically?

A
  • Memory impairment

- Behavioural changes

53
Q

What may Korsakoff’s Syndrome mimic?

A

Dementia

54
Q

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

A

3 months

Junior Medicine- GI (18 decks)

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