Alcoholic liver Disease (alcoholic hepatitis) Flashcards
3 stages to alcoholic liver disease?
(1) Fatty liver - reverses in 2 weeks if stop drinking
(2) Hepatitis - potentially reversible if permanently abstain
(3) Cirrhosis - irreversible
Recommended alcohol consumption?
14 units/week –> no more than 5 units in one session
How would you calculate units?
(%ABV x mls) / 1000
How would you quickly screen for harmful use?
CAGE:
- Cut down?
- Annoyed?
- Guilty?
- Eye-opener?
What screening test was developed by WHO?
AUDIT (Alcohol use disorders identification test)
Complications?
(1) Alcoholic liver disease
(2) Cirrhosis –> HCC
(3) Dependence, withdrawal
(4) Wenicke-Korsakoff Syndrome
(5) Pancreatitis
(6) Alcoholic cardiomyopathy
Signs of liver disease?
(1) Jaundice - yellow eyes, skin
(2) palmar erythema
(3) ascites
(4) hepatomegaly
(5) spider naevi
(6) easy bruising
(7) gynaecomastia
(8) asterixis
(9) Caput medusae - engorged superficial epigastric veins
Whats bloods would you take?
- FBC shows raised MCV
- LFTs shows
- -> elevated AST + ALT (>2:1 ratio) + gamma-GT. ALP raises later.
- -> low albumin
- -> high bilirubin if cirrhosis
- Clotting shows elevated PT
- U&Es deranged in hepatorenal syndrome
Scans?
US Liver - increased echogenicity
Fibroscan - degree of cirrhosis
CT/MRI scan - ascites, HCC, hepatospenomegaly
What investigation can be used to assess and treat oseophageal varices (if portal hypertension suspected)?
Endoscopy
Investigation to confirm diagnosis of hepatitis/cirrhosis OR if they’re starting steroids?
Liver biopsy
General management?
(1) stop drinking
(2) detox regime
(3) nutrition - high protein, thiamine
(4) prednisolone if acute/ severe (sort infection + GI bleeds first)
(5) liver transplant
Withdrawal symptoms at 6-12 hours?
- sweating
- tremor
- headache
- craving & anxiety
Withdrawal symptom at 12-24hrs?
Hallucinations
Withdrawal symptom at 24-48hrs?
Seizures
Withdrawal symptom at 24-72hrs?
Delirium tremens
Mortality of delirium tremens?
35%
Mechanism of delirium tremens?
Drinking alcohol stimulates GAMA receptors + inhibits glutamate/NMDA receptors –> relaxing effect on brain
Stopping drinking causes down-regulation of GABA and up-regulation of glutamate/NMDA system –> excitability of brain + excess adrenergic activity
Symptoms of delirium tremens?
- Acute confusion / agitation
- Delusions / hallucinations
- tremor
- tachycardia, hypertension, hyperthermia
- ataxia
- arrhythmias
What tool can be used to score a patient’s withdrawal symtpoms?
CIWA-Ar (Clinical Institute Withdrawal Assessment)
Medication to combat withdrawal effects?
Chlordiazepoxide (Librium) for 5-7 days
Other medication to consider?
B1 –> IV pabrinex or oral thiamine
Why is thiamine deficient in alcoholics?
(1) poorly absorbed in alcohol presence
(2) poor diet - alcohol as calories
Features of Wenicke’s encephalopathy?
(1) confusion
(2) oculomotor disturbance
(3) ataxia
Features of Korsakoff’s syndrome?
(1) memory impairment (anterograde + retrograde)
(2) behavioural disturbance
If pancreatitis was suspected, what additional features to liver disease might present?
Epigastric pain radiating to the back + significant rise in amylase
Liver transplant indications?
(1) pH <7.3 despite fluid resus
(2) All 3 of: creatinine >300, PT >100s + grade 3/4 encephalopathy
Signs of ascites?
Shifting dullness + fluid thrill
