Week 16 - Jaundice (alcoholic Liver Disease) Flashcards
At low levels, what is alcohol converted into in the body ?
CO2 and water
At higher levels, what is alcohol converted into in the body ?
Acetaldehyde
Then further converted into fatty acids and glycerol
How does high levels of alcohol intake cause hepatitis/liver dysfunction ?
High levels of alcohol are converted into acetaldehyde and then into fatty acids and glycerol in hepatocytes that can accumulate and cause inflammation = hepatitis
What are the top 3 ways alcohol damages the body ?
- Acetaldehyde is carcinogenic
- The fatty products can cause inflammation and fibrosis to the liver
- It induces enzymes (cp45) that prevents absorption/storage of nutrients like B vitamins
What are the stages of change in liver disease, in the order that they occur…?
- fatty liver = fats deposited in hepatocyte cytoplasm
- hepatitis = hepatic leukocytes is and loss of function
- fibrosis = reversible deposition of fibrous strands
- cirrhosis = irreversible nodules surrounded by fibrous tissue
- hepatocellular carcinoma = genetic changes inside the cell
True or false…
The lipophillic nature of alcohol allows it to easily cross the BBB and act on neurones ?
True !
What effect does alcohol have on the CNS at low levels?
It is a stimulant at low levels
What effect does alcohol have on the CNS at high levels?
Alcohol is a depressant at high levels, acting via GABA receptors
Which vitamin is most interfered with during chronic alcohol consumption ?
Vitamin B1 = Thiamine
What is vitamin B1 (thiamine) essential for in the CNS ?
Glucose metabolism
True or false…
At very high levels, alcohol acts on respiratory centres in the brain stem ?
True !
What are some medical, direct effects of alcohol ?
- 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
What are some pre-hepatic causes of jaundice ?
- haemolytic anaemia
- drugs
- Gilbert’s syndrome
- crigler-najjar syndrome (rare)
What are some hepatic causes of jaundice ?
- 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…)
What are some post-hepatic causes of jaundice ?
- pancreatitis
- gall stones
- surgical strictures
- pancreatic cancer
What are good questions to ask while history taking for a jaundiced patient ?
- 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
What are some signs of chronic liver disease that are a result of high oestrogen levels in this condition ?
- palmar erythema
- spider naevi
- gynaecomastia
- loss of body hair in males
- genital atrophy in males
What are some signs of chronic liver disease that are a result of high oestrogen levels in this condition ?
What are some signs of chronic liver disease that are a result of low albumin levels in this condition ?
Leukonychia
= white nails/white spots on nails
What are some signs of chronic liver disease that are a result of portal hypertension in this condition ?
- caput medusae (swollen veins around umbilicus)
- ascites
What are examination findings that could indicate chronic liver disease ?
- palmar erythema
- spider naevi
- leukonychia
- caput medusae (dilated abdominal veins)
- ascites
- liver flap (asterixis)
- hepatic encephalopathy (confusion)
- sarcopeania (muscle loss)
What symptoms are commonly associated with obstructive jaundice ?
- jaundice (of skin and eyes)
- itch (often nocturnal)
- light stools and dark urine
In obstructive jaundice, what is first to happen…
A) pale stools ?
B) dark urine ?
Dark urine is first /present in incomplete obstruction
Pale stools requires complete biliary obstruction
Name some causes of obstructive jaundice …
- pancreatic cancer
- common bile duct stones
- benign biliary structure
