Flashcards in Alcoholic Liver Disease Deck (11):
chonic liver disease from alcoholic fatty liver to alcoholic hepatitis and cirrhosis, due to excessive long term alcohol consumption.
Direct hepatocyte effects-
- altered redox state
- oxidative stress and lipid peroxidation due to CYP and ETC induction
- Transcription factor effects
- Protein adduct formation
- Altered methionine and folate metabolism
Increased gut permeability causing kupffer cell activation-
- proinflammatory cytokine release
- hepatocyte apoptosis
- stellate cell activation
- collagen production and fibrosis
Basically fatty change, alcoholic hepatitis then cirrhosis.
- FA production as NAD used in alcohol metabolism.
- steatosis= hepatocyte injury/inflammation= stellate activation= myofibroblast proliferation, contraction, chemotaxis, fibrogenesis.
Also activated kuppfer cells= cytokines= hepatocyte apoptosis.
- perivenular and peisinusoidal fibrosis= cirrhosis.
- alcoholic hep= cirrhosis.
The cirrhosis =
- clotting dysfunction, oncotic pressure, N elimination, bilirubin conjugated problems.
- complications of HTN eg varicies, ascites, encephalopathy, spider naevi, malnutrition, splenomegaly, testicular atrophy.
- liver failure.
Bilateral parotid enlargement
If decompensated liver disease- jaundice, coagulopathy, ascites, encephalopathy, splenomegaly.
(NOT jaundice, ascites, or splenomegaly usually)
Leukocytosis, macrocytic anaemia, thrombocytopenia, increase prothrombin time.
Elevated AST to ALT ratio over 2.
Gamma glutamyl transpeptidase high.
Total bilirubin high.
Low serum albumin.
HypoK, Mg, Ca, P.
AUDIT or CAGE questionnaire
Cirrhosis biopsy mallory bodies
Abstinence support, maybe disulfiram.
No further treatment for fatty liver, and is generally reversible.
Steroids for alcoholic hepatitis, and infection screen. High mortality.
Nutrition, vits B,K.
Liver failure (transplant only option)
Wernicke korsakoff syndrome
Oesophageal varices (L gastric to azygos)
Prone to drug toxicity eg paracetamol.
Cholecystitis (positive Murphys)
Direct hepatocyte affects.
Alcohol metabolism uses NAD= more FA production.
Seatosis= hepatocyte injury and inflammation= stellate and kupffer activation= collagen production and cytokines= hepatocyte apoptosis.
Repeated nodular regneration= cirrhosis.
Decreased liver function and portal HTN.
Symptoms- tachyc, hypotension, tremor, confusion, fit, hallucination.
Treatment- chlordiazepoxide, vitamins K and B.