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Alcoholic liver disease

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Undergraduate summary of LFTs and Liver disease

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Alcoholic liver disease

  1. 1.  Functions of the liver Alcohol metabolism ALD Signs and symptoms Liver Function tests Complications Prognosis
  2. 2.  Storage – glycogen, vitamins, iron, copper Metabolism – Drugs (incl alcohol), carbohydrate, lipid, protein Production – Bile, albumin, clotting factors, hormones
  3. 3.  Acetate then oxidised in peripheral tissues via citric acid cycle to CO2, fatty acids and water, producing energy
  4. 4.  Three stages: Alcoholic fatty liver (Steatosis) Alcoholic hepatitis Cirrhosis
  5. 5.  Over 90% of chronic heavy drinkers will develop steatosis 10-20% will develop alcoholic hepatitis ALD cause of death of 1 in 50 people in Scotland. 4 fold increase in deaths from ALD in past 30 years. Risks: alcohol quantity/pattern, gender (F), Hep C infection, haemochromatosis, genetic factors, malnutrition, deprivation.
  6. 6.  Not just end result of alcoholism Non alcoholic fatty liver disease (NAFLD) Chronic Hepatitis B ± D or C PSC/PBC AI hepatitis Haemochromatosis Wilson’s disease
  7. 7.  Steatosis: usually asymptomatic, hepatomegaly Alcoholic hepatitis: malaise, jaundice, tender hepatomegaly, fever, weight loss, abdominal discomfort Cirrhosis: Similar to other causes of cirrhosis. Hepatomegaly, splenomegaly, malaise, jaundi ce, weight loss, ascites, signs of CLD
  8. 8.  History and Examination – Alcohol Bloods including FBC, U&Es LFTs, coagulation, cholesterol, glucose, liver screen Liver imaging – Ultrasound, CT/MRI
  9. 9.  Synthetic function ◦ Albumin, INR Hepatic enzymes ◦ AST, ALT Cholestatic enzymes ◦ Alk Phos, Gamma GT Inducible enzymes ◦ Gamma GT Bilirubin ◦ if isolated consider Gilberts or Haemolysis
  10. 10.  Hepatitis ◦ Increased ALT/AST, mild GGT mild Alk phos ◦ Serology Alcohol ◦ Increased ALT/AST, large GGT, moderate Alk phos ◦ Ethanol and MCV ◦ High AST:ALT (2:1) Gallstones/primary Biliary cirrhosis ◦ Large Alk Phos, Large GGT, mild ALT/AST
  11. 11.  PBC ◦ IgM + Antimitochondrial antibodies Autoimmune Hepatitis ◦ Anti ds-DNA, SMA, IgG and IgA Sclerosing cholangitis ◦ ANCA
  12. 12.  AST 4-50 77 27 1218 104 ALT 4-50 71 18 1055 114 ALK P 30-120 85 98 191 390 Bili <32 21 49 140 87 Albumin 36-46 41 43 31 39
  13. 13.  Differntial of large transaminitis ◦ Ischaemic Injury ◦ Acute Viral Hepatitis ◦ Paracetamol overdose
  14. 14.  Ascites Portal hypertensive bleeding Hepatic encephalopathy
  15. 15.  Peritoneal fluid accumulation – transudate Portal hypertension - ↑ pressure on portal vein Sodium and water retention due to vasodilatation (RAAS) Hypoalbuminaemia due to ↓ synthetic function of liver – low plasma oncotic pressure
  16. 16.  Engorged veins due to portal hypertension Develop in areas with collateral circulation Treatment: treat hypovolaemia, endoscopy, banding
  17. 17.  Neuropsychiatric abnormalities in those with liver disease and no attributable brain disease Neurotoxic substances bypass liver metabolism (eg ammonia)
  18. 18.  Child Pugh score – assesses the prognosis of chronic liver disease
  19. 19. One year Two yearPoints Class survival survival5-6 A 100% 85%7-9 B 81% 57%10-15 C 45% 35%
  20. 20.  Functions of the liver Alcohol metabolism ALD Signs and symptoms Liver Function tests Complications Prognosis

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