Symp 3 - Alcohol – Enemy of the Common Man Flashcards
what is alcohol related liver disease?
Alcohol-related liver disease is where your liver is damaged by drinking too much alcohol
Alcohol-related liver disease (ARLD) refers to liver damage caused by excess alcohol intake. There are several stages of severity and a range of associated symptoms
ARLD does not usually cause any symptoms until the liver has been severely damaged
what is the epidemiology of alcohol rleated hospital admissions?
what is the Safe Limit of Alcohol?
There is no safe amount of Alcohol
alcohol consumption can affect the whole body but:
what damage can be caused to the live due to alcohol abuse over long periods of time?
can cause acute alcoholic hepatitis which is a very serious condition
if at the stage of hepatic steatosis or alcoholic hepatitis then abstinence at this stage can help them
which is healtyh liver, which is fatty liver and which is cirrhosis?
Fatty liver - White globules of fat – happen hen drink excessive alcohol over a period of time
Chicken wire meshing around the portal track
CIrrhosis liver - Nodule formation, fibrosis and cirrhosis in the bottom picture
what is shown here?
Normal liver
Alcoholic fatty liver:
- Most Heavy drinkers will have _____ Liver (more than 10 units a day for 7 days)
- __% progress to cirrhosis
- Alcohol __________ improves Fatty Liver to normal
Fatty
20
Abstinence
what causes Acute Alcoholic Hepatitis?
•Alcohol intake > 6u / day
how does someone present with Acute Alcoholic Hepatitis?
- Jaundice with Bilirubin > 80mg/dl
- No other aetiology for Liver inflammation
- Very high Mortality / No specific treatment yet
Very serious condition
what do we use to measure alcoholic hepatitis?
Alcoholic Hepatitis GAHS score (Glasgow alcoholic hepatic score but there is any others but this is the one that we use)
GAHS ≥ 9:
•30 day mortality
- Without steroids 48%
- With steroids 22%
•84 day mortality:
- Without steroids - 62%
- With steroids - 41%
what is the epidemiology of ARLD & Hospital admission?
- 1 person admitted with ARLD / day
- Age at presentation is going down
- Mean length of stay is 9 days
- 1 death every 4.5 days at ARI
- Mean age at dying 58
Alcohol & Malnutrition - how common is it and how is it caused?
- 60 % of chronic abusers have malnutrition
- Most of the calories is from Alcohol
- Total energy intake is reduced:
- Nausea & Vomiting
- Abdo pain
- Diarrhoea
Alcohol is fermentation carbohydrate and this needs a lot of vitamins to absorb so all your body vitamins are used
Most patients are sarcopenic (muscles loss)
what is the Mortality in Alcoholic Cirrhosis?
- 75% die of Liver decompensation
- 20-25% Hepatocellular cancer sequelae
what is the most common indication for liver trnasplant an dhow does it help?
- <50 % 2 year survival without Transplant
- ARLD is the most common indication:
- Resistant complications of Cirrhosis
- Jaundice
- Ascites
•- ncephalopathy
- Coagulopathy
Hepatocellular Cancer (reduced incidence in these patients)
Alcohol and Teenagers - what is seen in teenagers?
- Cirrhosis is rare in Teenagers (secondary to alcohol)
- Deranged LFTs are common especially in Obese teenagers
- Exposure to Alcohol <14 yrs - Strongly associated with later alcohol abuse & dependence, (RR 2.3-4.0)
healthy liver = fatty liver then prolonged alcoho consumption = ……..
cirrhosis of the liver
Case:
36 Female
- Referred to GI clinic with Deranged LFTs (Went to GP for unrelated symptoms back pain)
- Tried several time to book an appointment and eventually succeeded
- 3 children 18, 8 & 3
- Husband offshore worker
- Obese
- No friends
- Smokes 10/ day
- Alcohol 2 bottles of wine/ night
Raised MCV, low urea, ALT and AST ratio reversed = someone drinking alcohol or dependant on alcohol
INR/prothrombin time is normal so is good
Ultrasound scan:
- Enlarged Fatty Liver
- Gall Bladder Normal
- Portal venous flow normal direction, no thrombus
- Spleen size normal (normal spleen means no portla hypertension)
- No ascites
Chronic liver screen:
- Hepatitis serology : Negative
- Autoantibody profile Negative
- Coeliac serology Negative
- Immunoglobulins: Normal
- Lipids : normal
- Caeruloplasmin: Normal
- A1AT: Normal
Large globules of fat in the hepatocytes in histology
This is a reversible condition
When engage in services there is a good prognosis
(Dec 2020) 36F:
- Now referred to ophthalmology with reduced vision
- Toxic Neuropathy: Alcohol/Nicotine
- ? Nutritional
- Need to check Vit B12, Folate & Ferritin.
Case 2:
75 male retired surgeon
- Left sided abdo pain
- Dark urine
- Swollen legs
- Evasive about Alcohol intake
- Says he had Glandular Fever / Lymes disease
Blood tests very deranged
MCV high
This man has increased INR
Albumin is low
Liver is failing compared to previous patient
Ultrasound scan:
- Multiple hypoechoic lesions within the Liver ? Metastases
- 10cm mass between spleen / left Kidney
CT scan triple phase Liver:
- Features of Liver cirrhosis with Nodularity
- Multiple lesions both lobes of liver
- Portal venous thrombus
- Mass between Spleen/ L Kidney
- Ascites
- Bony Metastases to Sternum/ 10th Rib
- Autoantibody Negative
- Hepatitis Serology Negative
•Alpha Feto Protein 61724
- Metastatic Hepatocellular cancer
- Patient died 6 weeks after clinic visit.
Case 3:
40 M
- Oil worker, travels a lot, high pressure job
- Presented with Haematemesis & Malena
- Long history of Alcohol intake / anxiety relief
- o/e spider naevi, Psoriasis, Hepatomegaly
- Endoscopy: Fresh Blood in stomach
- Unable to control bleeding
- Sengstaken tube inserted / ICU
- Transferred to Liver unit for TIPSS insertion
- Now remains abstinent past 2 months, LFTs improving
By doing TIPS we have controlled high bleeding
No alcohol and LFTs improving
Summary:
- No amount of alcohol is ____
- Early stages of ARLD are _______
- High ________ with AAH & Decompensation
- __________ approach vital in management
- Long term survival related to _______
- Liver ___________ improves QOL / survival
safe
reversible
mortality
Multidisciplinary
abstinence
Transplantation
