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07. Year 2: Alimentary System > Alcohol Related Disease > Flashcards

Alcohol Related Disease Flashcards

1
Q

Diseases from what system have the greatest mortality compared to the rest?

A

Liver diseases

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2
Q

Do woman or men metabolise alcohol slower?

A

Women

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3
Q

What causes a variation in alcohol toxicity?

A

Genetic variation

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4
Q

What is the pathway of ethanol metabolism?

A

Ethanol -> Acetaldehyde -> Acetate

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5
Q

What enzyme converts ethanol into acetaldehyde?

A

Alcohol dehydrogenase

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6
Q

What enzyme converts acetaldehyde into acetate?

A

Acetaldehyde dehydrogenase

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7
Q

What effects does alcohol have on the liver?

A

Steatosis (fatty liver)

Steatohepatitis (fatty liver with inflammation)

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8
Q

What does steatosis describe?

A

Process describing abnormal retention of lipids within a cell or organ

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9
Q

What is steatohepatitis?

A

Type of fatty liver disease characterised by inflammation of the liver with concurrent fat accumulation in the liver

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10
Q

What are causes of steatohepatitis?

A

Neutrophil infiltration

Fibrosis, cirrhosis (build up of scar tissue)

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11
Q

When taking a history to do with alcohol liver disease what acrynm should be remembered?

A

CAGE:

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

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12
Q

How much beer, wine and spirits is 1 unit of alcohol?

A

Half pint of beer

Small glass of wine

Single measure of spirit

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13
Q
A
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14
Q

What questionaire is used to determine alcoholism?

A

FAST questionaire

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15
Q

A score of what is FAST positive on a FAST questionaire?

A

3 or more

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16
Q

What do you do if someone gets a score of 3 or more on a FAST questionaire?

A

Complete remaining audit questions to obtain a full AUDIT score

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17
Q

When doing a full AUDIT score on a FAST questionaire, what is considered to be increasing risk, higher risk and possible dependence?

A

8-15 is increasing risk

16-19 is higher risk

20+ is possible dependence

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18
Q

What are physical findings for alcoholic liver disease?

A

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)

Jaundice

Muscle wasting

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19
Q

What can be seen in lab tests for alcoholic liver disease?

A

Asparate amino transferase (AAT) > alanine amino transferase (ALT), ratio > 2

Raised gamma glutamyl transferase

Macrocytosis

Thrombocytopenia (low platelets)

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20
Q

What imaging is done to look for a fatty liver?

A

Ultrasound scan

21
Q

What is hepatic encephalopathy?

A

Decline in brain function that occurs due to severe liver disease

22
Q

How is the severity of hepatic encephalopathy graded?

A

1 to 4

Where 1 is mild confusion and 4 is a coma

23
Q

What is the aetiology of hepatic encephalopathy?

A

Infection

Drugs

Constipation

GI bleed

Electrolyte disturbance

24
Q

What should be excluded before diagnosing hepatic encephalopathy?

A

Infection

Hypoglycaemia

Intra-cranial bleed

25
Q

What is the treatment of hepatic encephalopathy?

A

Bowel clear out, lactulose, enemas

Antibiotics

Supportive (ITU, airway support, NG tube for meds)

26
Q

What does SBP stand for?

A

Spontaneous bacterial peritonitis

27
Q

What is spontaneous bacterial peritonitis (SBP)?

A

Development of bacterial infection in the peritoneum, despite the absence of obvious source for the infection

28
Q

What are symptoms and signs of spontaneous bacterial peritonitis?

A

Abdominal pain

Fever, rigors

Renal impairment

Signs of sepsis such as tachycardia and temperature

29
Q

What investigations should be done for spontaneous bacterial peritonitis (SBP)?

A

Ascitic tap:

fluid protein and glucose levels

cultures

white cell content

30
Q

What is the neutrophil count for spontaneous bacterial peritonitis?

A

> 0.25 x 109/L

31
Q

What is the protein level for spontaneous bacterial peritonitis?

A

< 25g/L

32
Q

What is the treatment of spontaneous bacterial peritonitis?

A

IV antibiotics

Ascitic fluid drainage

IV albumin infusion (20% ALBA)

33
Q

What is alcoholic hepatitis?

A

Inflammation of the liver caused by drinking alcohol

34
Q

What is the presentation of alcoholic hepatitis?

A

Jaundice

Encephalopathy

Infection common

Decompensated hepatic function (low albumin and raised prothrombin time/INR)

35
Q

What is required for a diagnosis of alcoholic hepatitis?

A

Raised bilirubin

Raised GGT and AlkP

Alcohol history

Exclude other causes

36
Q

What is the prognosis of alcoholic hepatitis like?

A

Poor

40% mortality

If severe up to 90% mortality

37
Q

What is the treatment for alcoholic hepatitis?

A

Supportive

Treat infection

Treat encephalopathy

Treat alcohol withdrawal

Protect against GI bleeding

Airway protection/ITU care

Steroids (only if graded severe, Glasgow alcoholic hepatitis score > 9)

Nutritional (they are malnourished, give thiamine)

38
Q

What Glasgow alcoholic hepatitis score is required for steroids to be used as a treatment?

A

> 9

39
Q

What does the Glasgow Alcoholic Hepatitis score consider?

A

Age

White cell count

Urea

INR

Billirubin

40
Q
A
41
Q

Other than the Glasgow Alcoholic Hepatitis score, what is another way of evaluating the severity of alcoholic hepatitis?

A

Maddrey’s discrimination function

42
Q

What is the prognosis of alcoholic hepatitis dependent on?

A

Alcohol abstinence or ongoing consumption

43
Q

What are the different kinds of fatty liver?

A

Steatosis (non-alcoholic fatty liver disease, NAFLD)

Steatohepatitis (non-alcoholic steatohepatitis, NASH)

44
Q

What does NAFLD stand for?

A

Non-alcohlic fatty liver disease

45
Q

What does NASH stand for?

A

Non-alcoholic steatohepatitis

46
Q

What are risk factors for fatty liver?

A

Obesity

Diabetes

Hypercholesterolaemia

Alcohol

47
Q

What percentage of people with fatty liver develop cirrhosis?

A

25%

48
Q

What is the treatment for fatty liver?

A

Weight loss

Exercise

49
Q

What is required to diagnose fatty liver?

A

Raised alanine amino transferase

Fatty liver on USS

Liver biopsy

07. Year 2: Alimentary System (41 decks)

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