Gastro 13 - Alcoholic Liver Disease Flashcards
What is first degree of alcoholic liver disease?
Steatosis: fatty liver. Fat droplets within liver cells. Caused by heavy alcohol use. Potentially reversible.
What is the second stage of alcoholic liver disease? What are its traits?
Alcoholic hepatitis. Inflammation of the liver plus fat droplets (steatosis). Hepatocytes are swollen and necrotic. Neutrophils infiltrating the liver parenchyma. Mallory bodies are seen (eosinophilic deposits of keratin in liver cells).
What enzymes are elevated in alcoholic liver disease?
AST 2x higher than ALT.[A Scotch and Tonic]
What is the third stage of alcoholic liver disease?
Cirrhosis: scarring and fibrosis.
What are the two main effects of cirrhosis?
Liver failure. Portal hypertension.
What are the symptoms of hepatic encephalopathy?
Confusion, delirium, and hypersomnia. Coma and death. Asterixis. Fetor hepaticus (musty odor).
What are the symptoms of elevated estradiol levels due to hepatic failure?
Testicular atrophy. Gynecomastia. Spider telangiectasias. Palmar erythema.
Why does cirrhosis cause portal hypertension?
Because the hepatic scarring increases pressure in the hepatic sinusoids and causes blood to back up into portal vein, and back up further.
What is the problem does portal hypertension create in regards to venous blood flow?
Creates portosystemic shunts: An anastomosis b/w the portal venous system and the systemic veins in a way to relieve all this back pressure.
What are two sites of portosystemic shunts?
Esophageal varices. Umbilicus (creates head of medusa). Rectal veins: leads to hemorrhoids.
What is the treatment of esophageal variceal bleeding?
Octreotide (analog of somatostatin); it decreases visceral circulation. Ultimately need endoscopic banding of varices. Can use propranolol or nadolol. TIPS procedure (transjugular intrahepatic portosystemic shunt).
What are the symptoms of Portal hypertension?
Hepatomegaly. Splenomegaly. Ascites (which increase chance of spontaneous bacterial peritonitis (SBP)). Esophageal varices causing hematemesis and melena. Hemorrhoids. Caput medusae.
Why do we give lactulose on patients with cirrhosis?
So it can trap ammonia in the gut and be excreted in the stool. Reduces serum ammonia levels, helping treat hepatic encephalopathy.
What SAAG and why do we use it?
Serum-Ascites Albumin Gradient (SAAG) = [albumin]serum - [albumin]ascites. This helps determine the cause of ascites. If it is 1.1 or greater, then its caused by portal hypertension. If less than 1.1 due to cancer, nephrotic syndrome, tuberculosis, pancreatitis, biliary disease, connective tissue disease.
What cocktail of medications is commonly taken by patients suffering from severe cirrhosis?
Diuretics. Beta-blockers (nadolol or propranolol). Vitamin K. Lactulose.
