CC Nov 2014 Alcohol liver disease

echoecho's version from 2015-06-30 18:10


Question Answer
Alcohol liver disease is a spectrum of disorders ranging from what to what?from fatty liver infiltration (steatosis) to alcoholic hepatitis and finally cirrhosis
What is the most common form of alcohol-induced liver disease?steatosis
What is the less common cause of alcohol-induce liver disease and what is it's prognosis in comparison to steatosis?alcohol hepatitis; it has a worse short-term prognosis
Alcoholic hepatitis (the acute onset of symptomatic hepatitis) ranges from what?ranges from mild injury to acute life-threatening liver failure
What are the s/s of alcoholic liver disease?fever, jaundiace, hepatomegaly, ascites and/or encephalopathy
More severe dse is often seen in what type of pats?those with underlying chronic liver disease
What is the initial assessment of a patient presenting with acute alcoholic hepatitis?1. determination of prognosis 2. nutritional status
*** Prognosis in acute alcoholi hepaitis is best determined using what formula? What is the prognosis for values > 32? What is the 1 month mortality for values > 32? What is this calculation also used for?1. Maddrey's Discriminant Function (MDF): (4.6 x [prothrombin time - control]) + serum bilirubin 2. poor prognosis 3. 30-50% 4. used to direct therapy
Pts presenting with acute alcoholic hepatitis suffer from what deficiencies, give examples?1. nutritional deficiencies 2. vitamin and protein deficits
What is the treatment for these mentioned deficiencies?1. nutritional support 2. adequate caloric and protein support
List some vitamins used?thiamine, vitamin D, vitamin K, zinc, folate and pyridoxine (B6)
The 2010 American Assoc. for the study of Liver diseases suggest testing all pts w/ alcoholic hepatitis for vitamin and mineral deficiencies in addition to PEM, what is PEM?protein-energy malnutrition
PEM severity correlates with what?severity of disease and predicted mortality
Why is protein restriction (except in pts w/ severe disease) best avoided?it impedes hepatic repair and worsens liver function
Mild hepatitis patients should have a daily protein of ______ grams?100
Protein intake to produce a positive nitrogen balance may require up to ____ g/kg per day in more severe cases?1.5 g
IV therapy and bowel rest should be avoided unless there are contraindications to what?oral feedings
Guidelines recommend that pts w/ advanced disease (MDF score > ____) receive aggressive enteral nutritional therapy?32
Thos with an MDF of < _____ whose LFTs improve in the 1st week of hospitalization generally do not require this acuity of care?32
Salt restriction may be ncessary in persons who have what?ascites
***Pts with a MDF score > 32 should received what medication and what does, for how long?Prednisone (40 mg daily x 28 days) followed by a 2 week taper
***Pts who are poor candidates for or nonresponders to prednisone, may use what?phosphdiesterase inhibitor (pentoxifylline TRENTAL 400 mg TID x 4 weeks)
A Cochrane review states that pentoxifylline (Trental) may have a positive effective on ___ ____ mortality but is associated with increased risk of adverse effects some of which are serious?all-cause
Has combination therapy using both prednisone and pentoxifylline shown any additional benefit?no
Patients should be monitored for clinical response using what score?MDF score
What conditions of the hip have been reported in pts taking steroids longer than 1 month with 2 week taper so pt should be counseled about risk of steroids?aseptic necrosis of the hip
Name some medications that were studied that are not used as treatments based on clinical studies?colchicine, propylthiouracil, S-adenosyl L-methionine
What is the main stain of short and long term therapy?alcohol abstinence
Why are a majority of patients referred for liver transplantation secondary to alcohol, poor candidates for transplant?they continue to use alcohol