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Block 3 Year 3 > Week 16 - Jaundice (alcoholic Liver Disease) > Flashcards

Week 16 - Jaundice (alcoholic Liver Disease) Flashcards

1
Q

At low levels, what is alcohol converted into in the body ?

A

CO2 and water

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2
Q

At higher levels, what is alcohol converted into in the body ?

A

Acetaldehyde

Then further converted into fatty acids and glycerol

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3
Q

How does high levels of alcohol intake cause hepatitis/liver dysfunction ?

A

High levels of alcohol are converted into acetaldehyde and then into fatty acids and glycerol in hepatocytes that can accumulate and cause inflammation = hepatitis

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4
Q

What are the top 3 ways alcohol damages the body ?

A
  1. Acetaldehyde is carcinogenic
  2. The fatty products can cause inflammation and fibrosis to the liver
  3. It induces enzymes (cp45) that prevents absorption/storage of nutrients like B vitamins
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5
Q

What are the stages of change in liver disease, in the order that they occur…?

A
  1. fatty liver = fats deposited in hepatocyte cytoplasm
  2. hepatitis = hepatic leukocytes is and loss of function
  3. fibrosis = reversible deposition of fibrous strands
  4. cirrhosis = irreversible nodules surrounded by fibrous tissue
  5. hepatocellular carcinoma = genetic changes inside the cell
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6
Q

True or false…
The lipophillic nature of alcohol allows it to easily cross the BBB and act on neurones ?

A

True !

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7
Q

What effect does alcohol have on the CNS at low levels?

A

It is a stimulant at low levels

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8
Q

What effect does alcohol have on the CNS at high levels?

A

Alcohol is a depressant at high levels, acting via GABA receptors

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9
Q

Which vitamin is most interfered with during chronic alcohol consumption ?

A

Vitamin B1 = Thiamine

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10
Q

What is vitamin B1 (thiamine) essential for in the CNS ?

A

Glucose metabolism

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11
Q

True or false…
At very high levels, alcohol acts on respiratory centres in the brain stem ?

A

True !

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12
Q

What are some medical, direct effects of alcohol ?

A
  • acute intoxication
  • acute poisoning
  • hypertension
  • cirrhosis of liver
  • stroke
  • pancreatitis
  • wernickes encephalopathy
  • korsakoffs psychosis
  • depression
  • heart disease
  • cancer of mouth, throat, stomach, liver and breasts
  • peripheral neuropathy
  • teratogenicity
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13
Q

What are some pre-hepatic causes of jaundice ?

A
  • haemolytic anaemia
  • drugs
  • Gilbert’s syndrome
  • crigler-najjar syndrome (rare)
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14
Q

What are some hepatic causes of jaundice ?

A
  • viral infection (hepatitis)
  • alcohol
  • non-alcoholic fatty liver disease
  • autoimmune disorders (e.g primary biliary/sclerosing cholangitis)
  • malignancy of billiary system
  • drugs (co-amoxiclav, phenytoin, erythromycin, ciprofloxacin…)
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15
Q

What are some post-hepatic causes of jaundice ?

A
  • pancreatitis
  • gall stones
  • surgical strictures
  • pancreatic cancer
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16
Q

What are good questions to ask while history taking for a jaundiced patient ?

A
  • duration of jaundice
  • colour of urine/stools
  • pain (Socrates)
  • itching and systemic features (e.g anorexia, fevers, nausea/vomiting, fatigue etc)
  • alcohol consumption
  • recent travel abroad
  • PMHx (e.g gallstones, diabetes, autoimmune disease, recent surgery etc)
  • viral hepatitis risk factors (e.g sexual Hx, IV drug Hx, tattoos, blood transfusion etc)
  • medications (e.g co-amoxiclav)
  • family history
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17
Q

What are some signs of chronic liver disease that are a result of high oestrogen levels in this condition ?

A
  • palmar erythema
  • spider naevi
  • gynaecomastia
  • loss of body hair in males
  • genital atrophy in males
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18
Q

What are some signs of chronic liver disease that are a result of high oestrogen levels in this condition ?

A
19
Q

What are some signs of chronic liver disease that are a result of low albumin levels in this condition ?

A

Leukonychia

= white nails/white spots on nails

20
Q

What are some signs of chronic liver disease that are a result of portal hypertension in this condition ?

A
  • caput medusae (swollen veins around umbilicus)
  • ascites
21
Q

What are examination findings that could indicate chronic liver disease ?

A
  • palmar erythema
  • spider naevi
  • leukonychia
  • caput medusae (dilated abdominal veins)
  • ascites
  • liver flap (asterixis)
  • hepatic encephalopathy (confusion)
  • sarcopeania (muscle loss)
22
Q

What symptoms are commonly associated with obstructive jaundice ?

A
  • jaundice (of skin and eyes)
  • itch (often nocturnal)
  • light stools and dark urine
23
Q

In obstructive jaundice, what is first to happen…
A) pale stools ?
B) dark urine ?

A

Dark urine is first /present in incomplete obstruction

Pale stools requires complete biliary obstruction

24
Q

Name some causes of obstructive jaundice …

A
  • pancreatic cancer
  • common bile duct stones
  • benign biliary structure
25
Q

What blood tests would you request in the case of a jaundice patient ?

A
  • FBC (for infection/hasmolysis)
  • U+Es (for associated renal impairment)
  • LFTs (to confirm jaundice with raised bilirubin - assess pattern of abnormality)
  • clotting profile (assess liver function/vit k deficiency)

If LFTs show a hepatic picture, then…
- viral hepatitis screen
- auto-antibody screen
- ferritin

26
Q

What imagining tests should be requested as first line in a jaundice patient with suspected obstruction ?

A
  • USS abdomen
  • CT abdomen
27
Q

In cases of obstructive jaundice where cancer is suspected, what is the next scan to request after the USS diagnosed obstruction?

A

CT abdomen and pelvis to check for pancreatic cancer

add CT thorax to complete metastatic imaging

28
Q

What are normal plasma bilirubin levels ?

A

<21 mmol/L

29
Q

What substance binds with unconjugayed bilirubin in the blood to transport it back to the liver ?

A

Albumin

30
Q

What are the treatment options for pancreatic cancer ?

A
  • surgery to remove mass (whipple’s procedure) if resectable
  • chemo if a metastasis isn’t resectable
  • ERCP with biliary stent insertion if non-resectable, to relieve obstructive symptoms
31
Q

What is ‘Librium’ another name for ?

A

Chloradiazepoxide

32
Q

What is the drug chlordiazepoxide (Librium) used as?

A

A sedative and hypnotic medication

in the benzodiazepine class

33
Q

In what cases might you use Librium (chlordiazepoxide)?

A
  • Anxiety
  • Insomnia
  • Symptoms of acute withdrawal from alcohol or other drugs
34
Q

What are the risks of prescribing a patient Librium in agitated patients ?

A

It would be good to use in cases of alcohol withdrawal, however if the cause for agitation is something else then it could…

  • mask signs of the underlying issue
  • reduce phsyiological responses to the actual problem (good or bad)
  • cause respiratory depression
  • cause CNS depression
  • limit patients ability to give good history
  • worsen delirium
  • increase risk of falls
35
Q

What are some common physical symptoms of alcohol withdrawal ?

A

HATE SINS

  • Hallucinations
  • Agitation/anxiety
  • Tremors
  • Elevated pulse
  • Sweating
  • Insomnia
  • Nausea/vomiting
  • Seizures

Plus…
- cravings for alcohol
- palpitations
- diarrhoea
- confusion

36
Q

Why do patients with a Hx of excessive alcohol consumption have a higher risk of GI bleeds?

A

They’re at higher risk of …
- oesophagitis
- mallory weiss tears (tears of lower oesophagus)
- oesophageal varicose (less common)
- gastritis
- peptic ulcers

37
Q

How soon after stopping alcohol intake does autonomic hyperactivity (insomnia, tremors, anxiety, headaches etc) start ?

A

Immediate <6hrs

resolves within 24-48hrs

38
Q

How soon after stopping alcohol intake do withdrawal seizures start ?

A

< 12-24hrs

not usually recurrent or prolonged, so if they are either of these then there may be something else going on

39
Q

How soon after stopping alcohol intake does alcoholic hallucinosis start ?

A

Starts <12-24 hrs
Resolves within 24-48hrs

40
Q

Are hallucinations due to alcohol withdrawal usually….
A) auditory ?
B) visual ?
C) tactile ?

A

Usually visual but can be any

41
Q

Are patients experiencing hallucinations due to alcohol withdrawal aware that they’re hallucinating ?

A

Yes

42
Q

How soon after stopping alcohol intake does delirium tremens start ?

A

Starts 48-96hrs after cessation
Resolves within 1-5 days

43
Q

What is the most dangerous symptom of alcohol withdrawal ?

A

Delirium tremens

because often associated with abnormal vitals, dysrhythmias, fluid status and U+Es

Block 3 Year 3 (3 decks)

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