Alcoholic liver disease

Question 1

Define alcoholic liver disease

Answer 1

Chronic liver disease as a result of excessive alcohol consumption, including fatty liver, alcoholic hepatitis, and chronic hepatitis with fibrosis or cirrhosis

Question 2

Pathology of alcoholic liver disease

Answer 2

Fatty liver -> alcoholic hepatitis -> cirrhosis

1. Fatty liver - alcohol causes reduced NAD - less oxidation of fat so it builds up so steatosis. Hepatocyte injury due to oxidative stress
2. Alcoholic hepatitis - bloated hepatocytes contain Mallory bodies and neutrophils surround them. Fibrosis and foamy degeneration of hepatocytes.
3. Cirrhosis - irreversible damage - destruction of liver architecture and fibrosis

Question 3

Pathology of alcoholic liver disease

Answer 3

Fatty liver -> alcoholic hepatitis -> cirrhosis

1. Fatty liver - alcohol causes reduced NAD - less oxidation of fat so it builds up so steatosis. Hepatocyte injury due to oxidative stress
2. Alcoholic hepatitis - bloated hepatocytes contain Mallory bodies and neutrophils surround them. Fibrosis and foamy degeneration of hepatocytes.
3. Cirrhosis - irreversible damage - destruction of liver architecture and fibrosis

Question 4

Early signs and symptoms of alcoholic liver disease (6)

Answer 4

1. Abdominal pain
2. Nausea
3. Diarrhoea
4. Malaise
5. Fatigue
6. Loss of appetite

Question 5

Advanced signs and symptoms of alcoholic liver disease (think what liver functions are affected)

Answer 5

1. Jaundice
2. Oedema
3. Ascites
4. Fever
5. Pruritis
6. Hair loss
7. Clubbing
8. Palmar erythema
9. Significant weight loss
10. Muscle wasting
11. Dark stool and haematemesis
12. Confusion and memory problems
13. Insomnia
14. Easy bleeding/bruising

Question 6

CAGE screening

Answer 6

1. Have you ever felt you need to CUT DOWN?
2. Have you ever felt ANNOYED at someone telling you to reduce drinking?
3. Have you ever felt GUILTY about drinking?
4. Have you ever had an ‘EYE-OPENER’ (drink in the morning to prevent hangover + steady nerves)

Question 7

RF for alcoholic liver disease

Answer 7

1. Obesity
2. Women
3. Pre-existing liver condition (e.g hep C)
4. Genetics (alcohol dependance runs in the family)

Question 8

Management of alcoholic liver disease

Answer 8

1. STOP DRINKING
2. Withdrawal symptoms - benzodiazepine
3. Prevent relapse - acamprosate and dilsufiram (+CBT)
4. Diet - low salt, high carb + protein, more small meals
5. Corticosteroids - for liver inflammation
6. Thiamine - treat malnutrition
7. Liver transplant

Question 9

Management of alcoholic liver disease

Answer 9

1. STOP DRINKING
2. Withdrawal symptoms - benzodiazepine
3. Prevent relapse - acamprosate and dilsufiram (+CBT)
4. Diet - low salt, high carb + protein, more small meals

Question 10

Conditions for granting liver transplant

Answer 10

1. Develop liver failure despite not drinking
2. Fit for surgery
3. Commit to not drinking for the rest of their life

Question 11

Complications of alcoholic liver disease

Answer 11

1. Portal vein hypertension and varices -> split varices can lead to massive bleed or anaemia
2. Ascites -> peritonitis
3. Hepatic encephalopathy
4. Infection
5. Liver cancer