Alcoholism & Hepatitis - 205

Question 1

What is the most common cause of liver disease in the UK?

Answer 1

Alcohol

Question 2

What is the mechanism for a fatty liver in alcoholism?

Answer 2

NAD is used up in the metabolism of ethanol, this means that there is less available for gluconeogenesis, so less glucose is made resulting in a build up of fatty acids.

Question 3

What hepatic manifestations does alcoholic liver disease encompass?

Answer 3

Fatty liver, alcoholic hepatitis, hepatic fibrosis/cirrhosis

Question 4

How common is a fatty liver in alcoholics?

Answer 4

90% of alcoholics have a fatty liver

Question 5

What is alcoholic hepatitis and what causes it?

Answer 5

Inflammation of the liver - caused by the toxic effect of acetaldehyde. It presents acutely.

Question 6

Name 3 causes for chronic liver disease

Answer 6

Alcoholic Liver Disease
Chronic Viral Hepatitis
Obesity

Question 7

What is the route of transmission of Hepatitis A and Hepatitis E?

Answer 7

Oral-faecal

Question 8

What is the route of transmission of Hepatitis B and Hepatitis C?

Answer 8

Parenteral

Question 9

In the prodromal phase of hepatitis what might patients complain of?

Answer 9

Flu-like symptoms, anorexia, nausea, vomiting, fatigue, malaise, low-grade fever (<39.5), myalgia and mild headache.

Question 10

In the icteric phase of hepatitis what might patients complain of?

Answer 10

Dark urine, pale stools, GI symptoms, malaise, R upper quadrant pain, hepatomegaly, jaundice, fever

Question 11

What investigations would you do in a patient that you expect might have viral hepatitis?

Answer 11

FBC, U&E, LFTs, clotting, serology, PCR

Question 12

Is there a vaccine present for Hepatitis A, B and E?

Answer 12

Yes! There is NOT a vaccine for Hep C or D

Question 13

Which viral hepatitis is there PEP (post exposure prophylaxis) available for?

Answer 13

Hepatitis B

Question 14

Which viral hepatitis is more common in gay men?

Answer 14

Hep. C

Question 15

Which viral hepatitis’ are treated with drugs? Which drugs?

Answer 15

Hep. B and C.
Hepatitis B -> Peg IFN, Tenofovir, Entercavir
Hepatitis C -> Peg IFN, Ribavirin, DAAs

Question 16

In what situation in Hepatitis D present?

Answer 16

In the presence of active Hepatitis B.

Question 17

What is the difference in metabolism between 1st and 2nd pass metabolism of alcohol?

Answer 17

1st pass uses alcohol dehydrogenase which is found in the cytoplasm
2nd pass uses microsomal ethanol oxidising system
- Both are used when the concentration of ethanol is so high that 1st pass metabolism cannot deal with it all.

Question 18

What is the risk of hypoglycaemia in someone that has just consumed a large amount of alcohol?

Answer 18

If the large alcohol metabolism were to coincide with a period when blood glucose is falling it could lead to hypoglycaemia

Question 19

What factors can exacerbate fatty liver progression to hepatitis?

Answer 19

Diet high in unsaturated fat

Deposition of excess iron in the liver

Question 20

What ion channels/receptors does ethanol affect?

Answer 20

GABA, NMDA, calcium channels

Question 21

What affect does ethanol have on the activity of GABA?

Answer 21

It enhances its effect. GABA is an inhibitory neurotransmitter and alcohol increases the inhibition

Question 22

What affect does ethanol have on glutamate?

Answer 22

Glutamate is an excitatory neurotransmitter and it’s effect is reduced by alcohol. (NMDA receptors inhibited)

Question 23

What is responsible for memory loss and alcohol consumption?

Answer 23

NMDA receptor inhibition.

Question 24

What is the definition of tolerance?

Answer 24

Decreased response to effects of a drug concentration after continued use

Question 25

What are some mechanisms underlying chronic alcohol tolerance?

Answer 25

Increase in number of and activity of enzymes that metabolise ethanol. More NMDA receptors -> different function

Question 26

What is the Himmelsbach hypothesis regarding withdrawal?

Answer 26

Withdrawal happens when the adaptations that characterise tolerance take place without the drug in the system

Question 27

Give an example of an opioid receptor antagonist that can be used to treat alcoholism

Answer 27

Naltrexone and Nalmefene

Question 28

What receptor does caffeine act on?

Answer 28

Adenosine receptor antagonist

Question 29

What is the triad of symptoms in Wernicke’s encephalopathy?

Answer 29

Encephalopathy, oculomotor disturbance, gait ataxia

Question 30

What is thought to cause Wernicke’s encephalopathy? (What is it?)

Answer 30

Acute neurological symptoms due to CNS damage caused by thiamine deficiency. WE can progress to Korsakoff’s syndrome and this occurs more commonly in patients who abuse alcohol

Question 31

How is Wernicke’s encephalopthy treated? How is Korsakoff’s syndrome treated?

Answer 31

WE -> thiamine supplements

Korsakoff’s -> pabrinex and lactulose

Question 32

When might ALT and AST levels be raised? (LFTS)

Answer 32

ALT and AST are found in hepatocytes and released in hepatocellular disease.

• If ALT and AST are raised by 10x or more -> acute viral hepatitis (HAV), O/D
• If ALT and AST are raised by 5x or more -> chronic hepatitis (HBC, HCV), alcoholic hepatitis

Question 33

When might ALP or GGT be raised? (LFTs)

Answer 33

They are released in response to damage to bile canaliculi and cholestatic disease

Question 34

If LFTs show increased levels of unconjugated bilirubin what could this point to?

Answer 34

Haemolysis or a congenital disorder such as Guilberts.

Question 35

If LFTs show increased levels of conjugated bilirubin what could this point to?

Answer 35

Infection, cholestasis.

Question 36

What could high levels of unconjugated bilirubin on a LFT be suggestive of?

Answer 36

Haemolysis. E.g. Guilbert’s Disease