Alcoholic liver disease

Question 1

How does alcoholic liver disease progress?

Answer 1

1. Alcohol related fatty liver
2. Alcoholic hepatitis
3. Cirrhosis

Question 2

What complications can occur because of alcohol?

Answer 2

Alcoholic liver disease
Cirrhosis
Alcohol dependence and withdrawal 
Wernicke-korsakoff syndrome (WKS)
Pancreatitis
Alcoholic cardiomyopathy

Question 3

What investigations should be carried out in alcoholic liver disease?

Answer 3

Bloods:
FBC - raised MCV
LFTs - elevated ALT, AST and GGT. ALP elevated later in disease
Albumin - low
Bilirubin - elevated
Clotting - increased PT
U&Es - may be deranged in hepatorenal syndrome

Ultrasound:
Fibroscan

Endoscopy:
Can be used to assess for and treat oesophageal varies when portal hypertension is suspected

CT and MRI scan

Liver biopsy

Question 4

What is the management for alcoholic hepatitis?

Answer 4

Stop drinking alcohol permanently

Nutritional support with vitamins (thiamine) and high protein diet

Steroids (e.g. prednisolone) for acute episodes

Pentoxyphylline is sometimes used

Transplant for severe disease if alcohol-free for 3 months