MEDICAL COMPLICATIONS OF ALCOHOL MISUSE

CIRRHOSIS

Presented by Dr. Glynn Jones to Clinical Officers at Lewanika Hospital, Mongu, Zambia (Via Skype)

Date: June 7, 2013

OVERVIEW CIRRHOSIS

• Definition

• Clinical Manifestation

• Management of Cirrhosis & Complications

Definition - What is it?

• Late stage of progressive hepatic fibrosis– It is irreversible in its advanced stages– It is potentially reversible in its early stages– Patients with cirrhosis are susceptible to a

variety of complications and their life expectancy is markedly reduced

Clinical Manifestations

• Physical findings• A coincidental finding during surgery,

radiological or laboratory investigation• May present with decompensated cirrhosis• Esophageal varices with hemorrhage• Ascites• Spontaneous bacterial peritonitis• Hepatic encephalopathy

Following slides demonstrate physical findings associated

with liver disease

Spider Angiomata

Palmar Erythema

Nail Changes: [Muehrche’s Nails]

Dupuytren’s Contracture

Gynecomastia (Male)

Ascites

Caput Medusae

Diagnosis of Ascites and determination of cause

• 1500 cc of fluid collection in abdomen before being able to detect on physical exam

• Dullness to percussion in flank region

• Ultrasound is gold standard for diagnosis

Diagnostic Paracentesis

• Left lower quadrant 14g angiocath• Cell count• Albumin• SAAG > 11g/l • 98% sensitivity for diagnosis of portal

hypertension• Cell count > 300 cells/ ml leukocytes indicative

of spontaneous bacterial peritonitis

Treatment of Portal Hypertension

• Tap fluid once to make diagnosis

• Low salt diet 2-4g / day

• Diuretics: – Lasix 40 mg– Aldactone 100 mg

• And titrate upwards to effect– Monitor weight– and renal function

Hepatic Encephalopathy

• Triggered by alcohol and sepsis

• Treatment– Lactulose: orally or rectally

Conclusion

• Alcoholic liver disease is common and preventable

• Complications can be managed and add quality of life to the patient