Gastroenterology 1 - Alcoholic Liver Disease Flashcards
3 stages of alcoholic liver disease
fatty liver changes (fully reversible in 2 weeks)
alcoholic hepatitis (reversible with abstinence)
cirrhosis - irreversible scarring
CAGE alcohol screening questions
Cut down
Annoyed
Guilty
Eye-opener
6 complications of alcohol
pancreatitis liver disease cirrhosis + HCC cardiomyopathy Wernicke-Korsakoff dependence + withdrawal
9 signs of liver disease
jaundice hepatomegaly bruising ascites asterixis (if decomp) spider naevi palamar erythema gynaecomastia caput medusae
4 key blood results in alcoholic liver disease
raised MCV in bloods raised ALT + AST GGT especially raised prolonged prothrombin time U+E derangement if hepatorenal syndrome
4 imaging modalities and indications with alcoholic liver disease
ultrasound - increased echogenicity shows fatty changes in liver
Fibroscan checks elasticity of liver and cirrhosis
endoscopy screens + treats varices if portal HTN suspected
CT/MRI - screen blood vessels, HCC, liver appearance, HSM
when is liver biopsy indicated with alcholic liver disease
in patients where steroid therapy is being considered (only successful short term with hepatitis not cirrhosis)
6 key steps in alcoholic liver disease mangement
stop drinking forever
detox regime
nutritional support - thiamine + high protein
steroids if not cirrhotic
treat complications of cirrhosis if there
refer for transplant if severe and 3 months dry
4 complications of cirrhosis
portal hypertension
varices
ascites
hepatic encephalopathy
4 stages of alcohol withdrawal 6-12 hours 12-24 hours 24-48 hours 24-72 hours
6-12 hours tremor, sweating, craving, anxiety
12-24 hours hallucinate!
24-48 hours seizures
24- 72 hours delirium tremens
why does delirium tremens occur?
alcohol exacerbates GABA levels but suppresses glutamate levels
thus without the chronic alcohol baseline, inadequate GABA and excessive glutamate are present
leads to over-excitablity of the brain
9 presenting features of delirium tremens
acute confusional state delusions / hallucinations severe agitation tremor tachycardia hypertension hyperthermia ataxia arrhytmias
3 aspects of managing alcohol withdrawal
CIWA-Ar tool - scores and advises treatment direction
Chlordiazepoxide 10-40mg every 1-4 hrs, check guidelines locally
used for 5-7 days
Pabrinex IV
Wernicke-Korsakoff what is it
chronic lack of thiamine
Wernicke’s encephalopathy first then Korsakoff irreversible psychosis
3 features of Wernicke’s
confusion
oculomotor disturbances
ataxia
medical emergency!
