Week 3.5 - Alcohol Related Liver Disease Flashcards
What are some alcohol related liver diseases?
- hepatic encephalopathy
- spontaneous bacterial peritonitis
- alcoholic hepatitis (specific to alcohol)
How is alcohol toxic to the liver?
- acetaldehyde is toxic and carcinogenic, causing flushing and diarrhoea.
- also forms foreign compounds with macromolecules, causing immune response of neutrophil infiltration
What causes variation in our abilities to metabolise alcohol?
- men better
- certain cultures
- genetics
How is alcohol metabolised?
oxidative metabolism from ethanol to acetaldehyde by alcohol dehydrogenase. then this is broken to acetate by acetaldehyde dehydrogenase
What is the issue with excess alcohol consumption?
- metabolism pathway is saturated so alcohol broken down by other pathways producing excess lipids, lactic acids and ketones as a product.
- gluconeogenesis is also impaired so glycogen cant break down - hyperglycaemia.
How does alcoholic liver progress?
steatosis, steatohepatitis, cirrosis, fibrosis,
What is the CAGE questionnaire?
to determine if someone is an alcoholic
- ever felt need to Cut down?
- Annoyed at being asked about it?
- Guilty?
- Eyeopener drink first thing in morning?
What scoring systems are used to see if an individual is at risk of harmful drinking?
FAST and AUDIT.
- FAST if 3+ do audit
What are symptoms of alcohol related liver disease?
most have no symptoms until advanced stage. symptoms of liver disease like
- spider nave,
- palmar erythema,
- ascites,
- muscle wasting
- jaundice,
What LFT’s do we look at to indicate alcohol related liver disease? (3+1)
- AST/ALT (AST higher)
- Gamma GT higher
- thrombocytopenia (low platalets)
- ultrasound show fatty liver but not specific to alcohol related
Why do we see hepatic encephalopathy in alcohol patients?
ammonia no longer broken down efficiently. toxins and metabolites in blood and bowel barrier broken so ammonia from bacteria passes.
How do you grade and treat hepatic encephalopathy in alcohol patients?
- grade 1-4 from mild confusion to coma
- give antibiotics, look for cranial bleed, bowel clearance, may need intensive care due to consciousness
What is Spontaneous bacterial peritonitis? symptoms?
- not specific to alcohol but common
- infected ascites.
- sepsis, tachycardia, fever, pain
How do you test for Spontaneous bacterial peritonitis?
- fluids ascites tap
- white count above 0.25
- low protein
- cultures for bug
How do you treat Spontaneous bacterial peritonitis?
- IV antibiotics
- ascites drainage
- IV albumin to reduce ascites
