Alcoholic liver disease (ALD) + alcoholism

Question 1

1) What is the first stage of ALD?
2) What happens in this stage?
3) What is the second stage of ALD?
4) What happens in this stage?
5) What is the third stage of ALD?
6) What happens in this stage?

Answer 1

1) Alcohol related fatty liver
2) Drinking alcohol leads to the buildup of fat in the liver but is reversible
3) Alcoholic hepatitis
4) Drinking alcohol over a long period causes inflammation in the liver
5) Cirrhosis
6) Liver damage is irreversible as the liver is made up of scar tissue rather than healthy tissue

Question 2

Name 3 complications of excessive alcohol consumption

Answer 2

• Alcoholic liver disease
• Cirrhosis and the complications of cirrhosis
• Alcohol dependence and withdrawal
• Wernicke-Korsakoff syndrome (WKS)
• Pancreatitis
• Alcoholic cardiomyopathy

Question 3

Name 4 signs of liver disease

Answer 3

• Jaundice
• Hepatomegaly
• Spider Naevi
• Palmar Erythema
• Gynaecomastia
• Bruising – due to abnormal clotting
• Ascites
• Caput Medusae – engorged superficial epigastric veins
• Asterixis – “flapping tremor” in decompensated liver disease

Question 4

Name 3 things that may be elevated on a blood test of someone with ALD

Answer 4

• MCV (mean corpuscular volume)
• AST
• ALT
• ALP
• Gamma GT
• Prolonged prothrombin time

Question 5

Name 3 investigations that can be done for ALD

Answer 5

• Ultrasound
• Endoscopy
• CT and MRI
• Biopsy

Question 6

Name 3 aspects of the general management of ALD

Answer 6

• Stop drinking alcohol permanently
• Detoxification regime
• Nutritional support with vitamins
• Treat complications of cirrhosis
• Referral for liver transplant in severe disease however they must abstain from alcohol for 3 months prior to referral

Question 7

Name 3 symptoms of alcohol withdrawal

Answer 7

• Tremor
• Sweating
• Headache
• Craving
• Anxiety
• Insomnia
• Agitation
• Hallucinations

Question 8

1) What is delirium tremens?
2) What is the pathology behind delirium tremens?
3) Name 3 ways delirium tremens presents
4) How is delirium tremens managed?

Answer 8

1) Medical emergency associated with alcohol withdrawal
2) Chronic alcohol use results in the GABA system becoming down-regulated and the glutamate system becoming up-regulated to balance the effects of alcohol. When alcohol is taken away GABA under-functions and glutamate over-functions causing an extreme excitability of the brain with excess adrenergic activity
3) Acute confusion, severe agitation, delusions and hallucinations, tremor, tachycardia, hypertension, hyperthermia, ataxia and arrhythmias
4) Oral lorazepam

Question 9

Name a benzodiazepine that can be used to combat the effects of alcohol withdrawal?

Answer 9

Chlordiazepoxide or diazepam

Question 10

1) What is Wernicke’s encephalopathy caused by?
2) Which group of patients is this most commonly seen in?
3) Wernicke’s encephalopathy is a triad of what 3 things?

Answer 10

1) Vitamin B1 (thiamine) deficiency
2) Alcoholics
3) Confusion, ataxia, ophthalmoplegia/nystagmus

Question 11

1) What can untreated Wernicke’s encephalopathy cause?
2) What occurs in this condition?
3) How is it treated?

Answer 11

1) Korsakoff syndrome (Wernicke-Korsakoff Syndrome)
2) Antero and retrograde amnesia
3) Thiamine replacement

Question 12

What medication are currently indicated in the management of patients presenting with severe alcoholic hepatitis?

Answer 12

Corticosteroids

Question 13

When does alcoholic ketoacidosis in alcoholics occur?

Answer 13

Following an episode of reduced food intake

Question 14

What is the management of alcoholic ketoacidosis in alcoholics?

Answer 14

IV saline 0.9% and thiamine