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General Medicine Pt1 > Alcoholic liver disease and NAFLD > Flashcards

Alcoholic liver disease and NAFLD Flashcards

1
Q

Describe the illness course of alcoholic liver disease

A
  • Fatty liver (reversible)
  • Alcoholic hepatitis
  • Alcoholic cirrhosis (micronodular)
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2
Q

Define cirrhosis.

Differentiate between compensated and decompensated.

A
  • Fibrosis and nodular regeneration of liver cells
  • Interferes with liver blood flow and functions
    • Synthetic; metabolic; and excretory
  • Final histological pathway for a variety of liver diseases.
  • Compensated: Effective liver function; no/few noticeable clinical symptoms
  • Decompensated: Ineffective liver function; overt clinical complications
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3
Q

Describe the pathophysiology of cirrhosis

A
  • Irreversible damage to liver architecture ➔ fibrosis
  • Distorts hepatic vasculature
    • Increased intrahepatic resistance and portal HTN
  • Damage to hepatocytes ➔ impaired liver function
    • Synthetic; metabolic; excretory
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4
Q

What are the functions of the liver?

A
  • Metabolic
    • Drugs, toxins
    • Bilirubin
    • Glycogen store
  • Synthetic
    • Coagulation factors
    • Albumin
    • Hydroxylation of Vitamin D3
    • Extraction of androstenedione for testosterone
  • Excretion of bile
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5
Q

Name five causes of cirrhosis

A
  • Alcohol misuse: commonest cause in the West
  • Hepatitis B/C: commonest cause worldwide
  • NAFLD: Obesity or T2DM
  • Autoimmune: PBC; PSC; Autoimmune hepatitis
  • Genetic: Hereditary haemochromatosis; Wilson’s disease; Alpha-1-antitrypsin deficiency; CF; Classic galactosaemia
  • Veno-occlusive disease; Hepatic venous congestion
  • Drugs: Methotrexate
  • Glycogen storage disease; Sarcoidosis
  • Idiopathic
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6
Q

What is used to assess the severity of cirrhosis?

A

Child-Pugh classification The following are each scored out of 3 -Albumin -Bilirubin -Encephalopathy -Ascites -Prothrombin Time Grade A (<7) Grade B (7-9) Grade C (10+) *Variceal bleeding risk increases significant if score >8

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7
Q

List five symptoms of cirrhosis

A
  • Asymptomatic or non-specific symptoms
    • Malaise; fatigue; anorexia; nausea; weight loss; muscle wasting; abdominal pain
  • Right hypochondriac pain
  • Abdominal distension
  • Ankle swelling: hypoalbuminaemia
  • Haematemesis and melaena
  • Pruritus: cholestasis
  • Gynaecomastia; loss of libido; amenorrhoea
  • Confusion and drowsiness: hepatic encephalopathy
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8
Q

List 5 signs of compensated cirrhosis

A
  • Palpable left liver lobe; hepatomegaly; splenomegaly
  • Stigmata of chronic liver disease
    • Xanthelasma: PBC
    • Parotid enlargement: alcohol abuse
    • Spider navei
    • Palmer erythema
    • Leukonychia, Terry’s nails
    • Muscle wasting
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9
Q

Give three events that cause decompensation of liver disease

A
  • Infection
  • Portal vein thrombosis
  • Surgery
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10
Q

List five signs of decompensated chronic liver disease

A
  • Jaundice
  • Abnormal bruiding
  • Peripheral oedema
  • Ascites
  • Sepsis
  • Variceal bleeding
  • Asterixis (hepatic-flap)
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11
Q

List three complications of cirrhosis

A
  • Portal HTN:
    • Ascites, splenomegaly; hepatic hydrothorax
      • Increased risk of spontaneous bacterial peritonitis; hyponatraemia; hepatorenal syndrome
    • Oesophageal variceal bleed, caput medusae
  • Hepatic failure:
    • Hepatic encephalopathy
    • Infection; sepsis
    • Coagulopathy: Portal vein thrombosis
  • Increased risk of hepatocellular carcinoma
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12
Q

What is spontaneous bacterial peritonitis?

A

A form of peritonitis usually seen in ascited secondary to cirrhosis

Suspect if:

  • Ascites
  • Abdominal pain/tenderness
  • Low-grade fever

Diagnosis via ascitic tap and culture: neutrophil >250 cell/uL

Treatment with IV cefotaxime

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13
Q

How is cirrhosis diagnosed?

A

Do not use routine laboratory liver blood tests to rule out cirrhosis

  • Offer transient elastography for:
    • Hepatitis C
    • Chronic alcohol abuse (M: >50 units; F: >35 units)
    • Diagnosed with alcoholic liver disease
  • Otherwise, refer to hepatologist or gastroenterologist
  • Enhanced liver fibrosis test for NAFLD plus advanced liver fibrosis
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14
Q

Which investigations should always be measured in young cirrhotics?

A
  • Serum copper
  • Serum alpha-1-antripsin
  • Total iron-binding capacity; ferritin
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15
Q

List four poor prognostic indicators for cirrhosis

A
  • Low albumin <28g/L
  • Low serum sodium <125mmol/L
  • Prolonged Prothrombin time >6s above normal
  • Raised creatinine >130micromol/L
  • Failure to respond to medical therapy
  • Persistent jaundice; Persistent hypotension
  • Ascites; variceal bleed; gepatic encephalopathy; small liver
  • Continued alcohol intake if alcoholic cirrhosis
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16
Q

What is non-alcoholic fatty liver disease?

A

Excess fat accumulation (steatosis) in the liver, in the absence of excess alcohol consumption. Women: <20g/d ethanol Men <30g/d ethanol

17
Q

Describe the illness course of non-alcoholic fatty liver disease

A

Steatosis (90%): excess fat accumulation Non-alcoholic steatohepatitis ‘NASH’ (1-3%) Cirrhosis (1%)

18
Q

What are the risk factors for non-alcoholic fatty liver disease?

A

Obesity HTN T2DM Hyperlipidaemia *Think of NAFLD as the liver component of metabolic syndrome

19
Q

How does non-alcoholic fatty liver disease present?

A

Often asymptomatic: incidental finding on liver USS May cause nonspecific symptoms of fatigue, malaise, and abdominal discomfort NAFLD is the commonest cause of abnormal LFTs in the UK

20
Q

How is non-alcoholic fatty liver disease investigated?

A

Commonly an incidental finding on liver USS NICE recommends enhanced liver fibrosis (ELF) blood test LFTs: commonest cause of abnormal LFTs in the UK Frequently has mild increases in ALT>AST

21
Q

Outline the management of non-alcoholic fatty liver disease

A

Weight loss and exercise Strict control of HTN, diabetes, and lipid levels Alcohol advice

22
Q

What complications can occur from non-alcoholic liver disease?

A

Liver: Portal HTN, variceal haemorrhage, liver failure, HCC, sepsis Metabolic: CV disease, impaired glucose regulation, T2DM

General Medicine Pt1 (25 decks)

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