Alcoholic Liver Disease

Question 1

What are the three stages of alcoholic liver disease?

Answer 1

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

Question 2

If someone stops drinking at stage 1 of alcoholic liver disease, how long will it take for the liver to recover?

Answer 2

2 weeks

Question 3

What is the upper limit for the amount of alcohol someone should consume in a week in units?

Answer 3

14 units

No more than 5 units a day, 14 units to be spread out over 3 or more days

Question 4

The CAGE scoring system is used to screen for harmful alcohol use, what does each point stand for?

Answer 4

CAGE

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 a hangover?

Question 5

The AUDIT questionnaire on harmful alcohol use uses how many how many questions and what score does one need to indicate harmful use?

Answer 5

10 questions

8 or more is harmful use

Question 6

What are the complications of alcohol?

Answer 6

ALD

Cirrhosis and complications of it including hepatocellular carcinoma

Alcohol dependence and withdrawal

Wernicke-Korsakoff syndrome

Pancreatitis

Alcoholic cardiomyopathy

Question 7

What are the signs of liver disease?

Answer 7

Jaundice 
Hepatomegaly
Spider Naevi 
Palmar Erythema
Gynaecomastia 
Bruising (abnormal clotting)
Ascites 
Capital madusae 
Asterixis

Question 8

What blood tests are done for ALD and what would they show?

Answer 8

Bloods:
FBC raised MCV

LFT elevated AST, ALT and gGT and ALP in late disease, low albumin, elevated bilirubin in cirrhosis

Coag elevated prothrombin time

U+E may be changed in hepatorenal syndrome

Question 9

What investigations excluding blood tests can be done in ALD?

Answer 9

US scan to see early disease, fibroscan specifically to check elasticity of liver to assess degree of cirrhosis

Endoscopy to assess and treat oesophageal varices

CT and MRI

Liver biopsy

Question 10

What measures can be put in place for ALD patients?

Answer 10

Stop drinking alcohol permanently
Consider detox regime
Nutritional support with vitamins
High protein diet
Steroids to improve things in the short term in severe alcoholic hepatitis
Treat complications of cirrhosis
Referral for liver transplant but they must withdraw from alcohol for 3 months before referral

Question 11

What symptoms occur in alcohol withdrawal?

Answer 11

First 6-12 hrs: tremor, craving, headache, anxiety

Next: Hallucinations

After a day: seizures

Lastly: delirium tremens

Question 12

What are the symptoms of delirium tremens?

Answer 12

Confusion 
Agitation 
Delusions and hallucinations 
Tremor
Tachycardia 
Hypertension 
Hyperthermia
Ataxia
Arrhythmias

Question 13

What neurotransmitter is up regulated and which is down regulated in delirium tremens?

Answer 13

GABA down regulated

Glutamate up regulated

Question 14

What is used to manage alcohol withdrawal?

Answer 14

Chlordiazepoxide (Librium) - benzodiazepine given every 1-4 hours initially then titrated and given for up to 5-7 days

IV high dose B vitamins (pabrinex) followed by regular lower dose oral thiamine

Question 15

What vitamin deficiency leads to wernicke’s encephalopathy and eventually Korsakoff’s syndrome?

Answer 15

B1

Question 16

What are the signs of wernicke’s encephalopathy?

Answer 16

Confusion
Oculomotor disturbances
Ataxia (difficulty with coordinating movements)

Question 17

What are the signs of Korsakoff’s syndrome?

Answer 17

Memory impairment (retrograde and anterograde)

Behavioural changes