Alcoholic Liver Disease Flashcards
What is the stepwise progression of alcoholic liver disease
- Alcohol related fatty liver
* Reversible in 2 weeks if stop drinking - Alcoholic hepatitis
* Reversible c permanent abstinence - Cirrhosis
* Irreversible. Stop drinking to prevent further damage
What is the recommended alcohol consumption?
- Not drink more than 14 units in a week for both M&F
- Should be spread evenly over 3 or more days
- Not more than 5units a day
What questions can be used to quickly screen for harmful alcohol use?
- C – CUT DOWN? Ever thought you should?
- A – ANNOYED? Do you get annoyed at others commenting on your drinking?
- G – GUILTY? Ever feel guilty about drinking?
- E – EYE OPENER? Ever drink in the morning to help your hangover/nerves?
What other questionnaire is used to identify harmful use of alcohol?
- AUDIT
- Alcohol
- Use
- Disorder
- Identification
- Test
What are the signs of liver disease?
- Jaundice
- Hepatomegaly
- Spider Naevi
- Palmar Erythema
- Gynaecomastia
- Bruising – due to abnormal clotting
- Ascites
- Caput Medusae
- Asterixis
How does alcohol affect each organ?
- Liver
- alcoholic liver disease
- CNS
- memory/cognitive decline
- cortical atrophy
- retrobulbar neuropathy
- alcohol dependence & withdrawal
- Gut
- Obesity
- PUD
- pancreatitis
- Blood
- Macrocytic anaemia
- Heart
- Arrhythmias, high BP, cardiomyopathy
- Reproduction
- Testicular atrophy
- low testosterone and progesterone
What blood investigations would you order for alcoholic liver disease?
- FBC - raised MCV
- LFT - elevated ALT, AST, gamma-GT, bilirubin, low albumin,
- AST/ALT is 2:1
- Clotting test - elevated prothrombin
- U&E
What clotting factors does the liver produce?
- Hepatocytes
- fibrinogen
- prothrombin
- F5,7,9,10,11,12
- Protein C&S
- Antithrombin
- Liver sinusoidal
- F8
- vWF
What imaging can be used to assess alcoholic liver disease?
- Fibroscan
- check the elasticity of liver
- USS
- fatty changes/cirrhosis
- Endoscopy
- oesophageal varices
- CT & MRI
- fatty infiltration, hepatocellular carcinoma, hepatosplenomegaly, ascites
- Liver biopsy
- confirm cirrhosis
What is the general management for alcoholic liver disease?
- Stop drinking alcohol permanently
- Consider a detoxication regime
- Nutritional support with vitamins (particularly thiamine) and a high protein diet
- Steroids improve short term outcomes (over 1 month) in severe alcoholic hepatitis but infection and GI bleeding need to be treated first and do not improve outcomes over the long term
- Treat complications of cirrhosis (portal hypertension, varices, ascites and hepatic encephalopathy)
- Referral for liver transplant in severe disease however they must abstain from alcohol for 3 months prior to referral
How would you manage alcoholic hepatitis?
- Urinary catheter & CVP monitoring
- screen for infections +/- ascitic fluid tap
- stop alcohol consumption
- VitK, thiamine
- Avoid low protein diet
- monitor weight, LFT, U&E, INR
- Steroids
What are the sx for alcohol withdrawal?
- 6-12 hours: tremor, sweating, headache, craving and anxiety
- 12-24 hours: hallucinations
- 24-48 hours: seizures
- 24-72 hours: “delerium tremens
What is the px of delirium tremens?
- Alcohol stimulates GABA receptors in brain and inhibit glutamate receptors
- Chronic alcohol use results in down regulation of GABA system and upregulation of glutamate system
- Causes excess adrenergic activity of brain
What will delirium tremens present as?
- Acute confusion
- Severe agitation
- Delusions and hallucinations
- Tremor
- Tachycardia
- Hypertension
- Hyperthermia
- Ataxia (difficulties with coordinated movements)
- Arrhythmias
What tool can be used to score pt on their withdrawal sx?
- Clinical Institute Withdrawal Assessment - Alcohol revised (CIWA-Ar)
