Diseases from what system have the greatest mortality compared to the rest?
Do woman or men metabolise alcohol slower?
What causes a variation in alcohol toxicity?
What is the pathway of ethanol metabolism?
Ethanol -> Acetaldehyde -> Acetate
What enzyme converts ethanol into acetaldehyde?
What enzyme converts acetaldehyde into acetate?
What effects does alcohol have on the liver?
Steatosis (fatty liver)
Steatohepatitis (fatty liver with inflammation)
What does steatosis describe?
Process describing abnormal retention of lipids within a cell or organ
What is steatohepatitis?
Type of fatty liver disease characterised by inflammation of the liver with concurrent fat accumulation in the liver
What are causes of steatohepatitis?
Fibrosis, cirrhosis (build up of scar tissue)
When taking a history to do with alcohol liver disease what acrynm should be remembered?
Have you ever felt the need to CUT down
Have you been ANNOYED by criticism of your drinking
Have you felt GUILTY about your drinking
Do you need an EYEOPENER
How much beer, wine and spirits is 1 unit of alcohol?
Half pint of beer
Small glass of wine
Single measure of spirit
What questionaire is used to determine alcoholism?
A score of what is FAST positive on a FAST questionaire?
3 or more
What do you do if someone gets a score of 3 or more on a FAST questionaire?
Complete remaining audit questions to obtain a full AUDIT score
When doing a full AUDIT score on a FAST questionaire, what is considered to be increasing risk, higher risk and possible dependence?
8-15 is increasing risk
16-19 is higher risk
20+ is possible dependence
What are physical findings for alcoholic liver disease?
Majority have no physical findings until advanced liver disease
Signs of chronic liver disease (spider naevi, palmar erythema, gynaemocastia, loss of axillary and pubic hair, ascites, encephalopathy)
What can be seen in lab tests for alcoholic liver disease?
Asparate amino transferase (AAT) > alanine amino transferase (ALT), ratio > 2
Raised gamma glutamyl transferase
Thrombocytopenia (low platelets)
What imaging is done to look for a fatty liver?
What is hepatic encephalopathy?
Decline in brain function that occurs due to severe liver disease
How is the severity of hepatic encephalopathy graded?
1 to 4
Where 1 is mild confusion and 4 is a coma
What is the aetiology of hepatic encephalopathy?
What should be excluded before diagnosing hepatic encephalopathy?
What is the treatment of hepatic encephalopathy?
Bowel clear out, lactulose, enemas
Supportive (ITU, airway support, NG tube for meds)
What does SBP stand for?
Spontaneous bacterial peritonitis
What is spontaneous bacterial peritonitis (SBP)?
Development of bacterial infection in the peritoneum, despite the absence of obvious source for the infection
What are symptoms and signs of spontaneous bacterial peritonitis?
Signs of sepsis such as tachycardia and temperature
What investigations should be done for spontaneous bacterial peritonitis (SBP)?
fluid protein and glucose levels
white cell content
What is the neutrophil count for spontaneous bacterial peritonitis?
> 0.25 x 109/L