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Alcoholic Liver Disease (Public Health (Psychosocial Effects of Drinking…
Alcoholic Liver Disease
Epidemiology
Lifetime prevalence in males is 10%, females 4%
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Fatty Liver
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Fatty liver will either lead to alcoholic hepatitis or cirrhosis which will then end in alcohol decompensation
Alcoholic Hepatitis
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Investigations
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Cultures of blood, urine and ascetic fluid
U&Es - show hyponatraemia, elevated urea
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FBC - shows elevated MCV + WCC, thrombocytopenia
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Cirrhosis
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Complications
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Portal hypertension
Causes of portal hypertension: thrombosis, cirrhosis, schistosomiasis, congenital hepatic fibrosis, right heart failure, constrictive pericarditis, Budd-Chiari syndrome
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Investigations
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Bloods - LFT, raised bilirubin + AST + ALT, low WCC + platelets
Treatment
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Can only give a transplant to those with advanced cirrhosis secondary to alcoholic liver disease, hepatitis B+C, primary biliary cirrhosis, Wilson's disease, α1-antitrypsin deficiency, cancer
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Transplant is contraindicated in those with systemic sepsis, HIV, mets of cancer
Avoid NSAIDs, opiates and sedatives
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Rejection of transplant is T-cell mediated and occurs for 5-10 days. Hyperacute rejection is due to ABO incompatibility
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Public Health
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Alcohol Harm Paradox
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Low income groups drink less alcohol than higher income groups but they still experience greater alcohol related harm
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Foetal Alcohol Syndrome
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Congenital defects of ear, eyes, mouth, genitourinary tract, skeleton
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Interventions
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Secondary Prevention
AUDIT
Score 0-7 needs no intervention, score 8-19 needs advice
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FAST
If FAST positive (>3), complete AUDIT questions
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Clinical indications for screening: part of routine examination, before prescribing, in pregnancy, smokers, teens
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Alcohol Dependence
Patient has 3 or more events: tolerance, withdrawal, cannot stick to limits, spent a lot of time drinking
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= a set of behavioural, cognitive + physiological responses that can develop after repeated substance use. Manifested as a physical disturbance when the drug is withdrawn
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Tolerance = A state in where a person no longer responds to a drug. A higher dose is required to achieve the same effect