Alcohol-Related Liver Disease in England

This assignment delves into the issue of alcohol-related liver disease in England. It examines statistics on alcohol consumption, prevalence of liver disease, mortality rates linked to alcohol, and the impact on the NHS. The analysis utilizes data from sources like the Office for National Statistics, HSCIC, and medical organizations. The aim is to understand the scope of the problem and its implications for public health.

Health Information
and
Health Informatics

Table of Contents
INTRODUCTION...........................................................................................................................1
TASK- PART A ..............................................................................................................................1
A.1 Alcoholic liver disease (ALD) and its associated ICD-10 codes ........................................1
A.2 How the condition is diagnosed ..........................................................................................2
A.3 Description of its pathology, symptoms and complications ...............................................3
A.4 Description of prevalence of alcohol misuse in the England ..............................................4
A.5 Compare disease frequency /occurrence in England to that in other countries (developing
and developed) ...........................................................................................................................5
A.6 Present data from England (e.g. hospital admissions, primary care activity, and general
population data) and consider their reliability............................................................................5
A.7 Compare frequencies/occurrence in different regions of England.......................................6
A.8 Describe how frequency/occurrence varies with age, sex, and ethnic and socio-economic
groups..........................................................................................................................................8
A.9 Describe long term and more recent trends .........................................................................9
TASK- PART B ............................................................................................................................10
Summary........................................................................................................................................11
REFERENCES..............................................................................................................................12

Illustration Index
Illustration 1: Addressing liver disease in England.........................................................................4
Illustration 2: Alcohol related liver disease....................................................................................7
Illustration 3: Alcohol related deaths by age groups in England and Wales, 2012.........................8
Illustration 4: Alcohol related NHS hospital admission in England 2013/14..................................9
Illustration 5: Alcohol related deaths in England by gender.........................................................10

INTRODUCTION
In Health and Social Care (HSC), the term 'health information' refers to demographic data
regarding service users. In this, data is related to patient's medical history, clinical information,
test results, symptoms; diagnose procedures, notes and outcomes. In addition, health informatics
is type of interdisciplinary study that relates to design, development, adoption, application and
management of Information Technology (IT) based innovations in services of healthcare. The
present research report helps in understanding the concept of health information and informatics.
For this research, alcoholic liver disease in the England has been considered. It explores the
pathology, symptoms and complications in alcoholic liver disease. It also defines the digital
interventions for reducing harmful alcohol consumption.
TASK- PART A
A.1 Alcoholic liver disease (ALD) and its associated ICD-10 codes
The over consumption and misuse of alcohol causes the damage in liver. Various
researches on this subject explores that this disease mainly occurs after many years of heavy
drinking. In this context, liver disease which is related to consumption of alcohol fits in to three
types of categories such as fatty liver, cirrhosis and alcoholic hepatitis. This is defined below
(Table 1) as:
Table 1. Various forms of Alcoholic liver disease
Parameter Fatty liver Cirrhosis Alcoholic Hepatitis
For alcoholic cause,
histologic specificity
No No No
Prognosis Excellent Guarded Variable
Reversible chances Yes Usually No Uncertain
The alcohol consumption causes the inflammation in liver. The research of medical
science defines that cirrhosis is a final stage of ALD. In this, it is evaluated that as individual
drink heavily then, this progresses from one stage to another such as fatty liver to alcoholic
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hepatitis and next to cirrhosis. In this, International classification of diseases 10th version is a
procedure to classify and code all types of diseases and it is used by health care providers and
physicians (CD-10-CM Diagnosis Codes. 2016.). The ICD 10 codes for alcoholic liver diseases
are defined below (Table.2) as:
Table 2. ICD 10 codes for Alcoholic liver disease= K70->
Names of alcoholic liver disease ICD 10 codes
Fatty liver K70.0
Alcoholic Hepatitis
K70.1
(K70.10 without ascites)
(K70.11 with ascites)
Cirrhosis
K70.3
(K70.30 without ascites)
(K70.31 with ascites)
A.2 How the condition is diagnosed
ADL is potentially serious fatal consequences of over consumption and use of alcohol. In
this, diagnosis of this disease is usually based on physical signs, drinking history, laboratory tests
and symptoms. At initial stage, ALD is suspected when tests define the damaged medical
condition of liver. In accordance to this, health care professionals usually arrange a blood test
check-up to evaluate working pattern of liver (Blachier and et.al., 2013). In blood test, level of
protein substance such as serum albumin is detected. If results describe low level presence of
serum albumin then, it defines that liver is not functioning properly. The reason is that this type
of protein is made by itself liver so its fluctuation in this defines its working patterns. Further,
they ask several questions in order to identify the alcohol consumption history. When it is clear
from blood test that liver is affected then, several other types of tests are made such as: Imaging tests- Scans are carried out to explore detailed view images of liver. For this,
few scans are included such as ultra sound, CT (Computerised Tomography) and MRI
(Magnetic Resonance Imaging).
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 Liver Biopsy- A small needle is inserted into liver and small sample portion of liver cell
is taken out. In laboratory, under microscope that small sample is examined. This scan
determines the cause of damage and scarring degree in liver.
 Endoscopy- A long, flexible tube with video camera attached at end inserted into
stomach. This scan evaluates the sign of swollen veins (Alcohol-related liver disease –
Diagnosis. 2015.).
A.3 Description of its pathology, symptoms and complications
Pathology- Through the two main pathways like cytochrome P-450 2E1 and alcohol
dehydrogenase, alcohol is metabolised.
Symptoms- After a period of heavy drinking, the symptoms tend to get even worse. There are
various types of symptoms are present such as:
Skin symptoms
 Yellow colour in mucus membranes, eyes and skin
 Very pale and dark skin
 Redness on hands and feet
 Itching Spider veins (Williams and et.al., 2014)
Brain and nervous
 Problem in memory, thinking and mood
 Numbness in feet and legs
 Light headedness Fainting
Digestive
 Swelling & pain in abdominal part
 Weight loss and decreased appetite
 Fatigue and vomiting Increased thirst and dry mouth (Facts about liver disease. 2016)
Complications of alcoholic liver disease
 Enlarged veins
 Kidney failure chances
 Jaundice
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 Ascites
 High blood pressure
 Hyper tension
 Liver cancer
 Muscle stiffness (Alcohol-related liver disease – Complications. 2015)
A.4 Description of prevalence of alcohol misuse in the England
In the England, it is evaluated that many death reasons are related to smoking and alcohol
consumption in over manner. In addition to this in 2014, it was registered that approximately
8,697 people deaths caused due to consumption and misuse of alcohol in the UK. In same year,
the majority of alcohol related deaths were among males which was nearly about 65%. The
research defines that death rate due to this reason in 2014 is higher as compared to observed in
1994 (Alcohol related deaths. 2016). Further, if past records are examined then, it is observed
that 19% death rates were increased as compared to year 2001. So, in England itself, 6,490
deaths were caused in 2012. The over consumption and misuse of alcohol is considered as the
third biggest lifestyle risk factor in the UK. The research study also defines that per year misuse
of alcohol caused around £21bn costs to the England in crime, health care and productivity costs.
The main reason of misuse is also considered that alcohol is 61% more affordable as compared
to 1980 (Statistics on Alcohol England. 2015).
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Illustration 1: Addressing liver disease in England
Source; (Facts about liver disease. 2016)

The Image 1. defines that in 2010 the percentage of liver disease in UK increase in very
fast manner as compare to other diseases. The other key facts also defines that increment in year-
on-year, liver disease is the major cause of death rates in England. In 2008, approx 13,805 people
in England and Wales died from liver disease (Drug use, alcohol and smoking. 2016).
A.5 Compare disease frequency /occurrence in England to that in other countries (developing
and developed)
The several research studies defines that not only England is suffered from this disease
but other countries are also facing this. In this context, the alcohol is overly misused and
consumed at large scale at global level. In this context, the death rates due to alcoholic liver
disease by countries are defined below (Table 3.) as:
Table 3. Liver disease death rates intervals for 1980 & 2000
Region/ Country 1980 2000
Japan 19029 21225
China 144316 155645
England 8975 12558
Sri Lanka 1047 2942
Australia 1397 1417
France 16684 119987
India 77741 156383
A.6 Present data from England (e.g. hospital admissions, primary care activity, and general
population data) and consider their reliability
In present time, many health care organisations of England in 2010 describes that
admission of male patients of 15-24 years increased by 5 % from 18365 to 27747. In same way
the for female patients who are in age of 15- 24 years also died with same reason. In this, their
percentage increased at very fast rate from 15233 (2000) to 26900 (2010). In this many care
organisation also accepted that 11 % adults age of 15-16 years had sex after consumption of
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alcohol in excessive manner. Along with this, in England, hepatitis B increased from 87 (1992)P
to 1151 in 2003. The NHS defines that near about 4580 people in 2007 died in England from
the alcoholic liver disease. The several researches explore that in last 30 years, approximately 41
% death rates are increased between 1999 and 2005 (Liver disease biggest cause of alcohol-
related deaths in England and Wales. 2014). All these deaths causes due to alcohol related liver
disease. In this context, hospital admissions have more than doubled in intervals of 1995, 2002
and 2006. It is evaluated that there was near about 71 % death rates increased. In this respect,
there are more than 800,000 hospital admissions were directly related to the alcohol consumption
and misuse each year. It is clear that liver disease is the major cause of morbidity and mortality
and it is on increase in England. The above statics also points out that deaths from liver disease
with alcohol consumption have reached at record level per year. In addition, NHS estimates that
near about 9 % men and 4 % women in England shows the sign of high level dependence on
alcohol (Statistics on alcohol. 2016).
A.7 Compare frequencies/occurrence in different regions of England
In the year 2010, there was total of 8,790 deaths due to alcohol-related liver disease.
There was 126 more deaths from the previous year 2009. Out of the total deaths 67 % were
males. North East and North West regions has the highest number of people who were reported
to suffer from alcohol-related liver disease while East England had the lowest.
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Illustration 2: Alcohol related liver disease
(Source: Alcohol-related deaths in the United Kingdom, 2010)
It has been seen that the number of people consuming alcohol has increased in all the regions of
England. As a result the liver diseases had also increased. The female population consuming
alcohol has also shown significant rise. Both males and females are from the age group of 35-74.
The death rate was highest in the age group of 54-74 while it was lowest in below 35 age group.
70 % of the liver diseases are responsible alcohol related deaths. In England and Wales the
deaths are estimated to be between 18,000 and 30,000 per year (Alcoholic Liver Disease. 2012).
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A.8 Describe how frequency/occurrence varies with age, sex, and ethnic and socio-economic
groups
By considering the age, in 2012 school pupils near about 43 % accepted that they had
drunk at least once. The research studies also defines that between age of 15-34 years, in which
121 were females and 193 were males died just because of alcohol consumption in 2011 (Focus
On: Chronic Diseases and Conditions Related to Alcohol Use. 2013).
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Illustration 3: Alcohol related deaths by age groups in England and Wales, 2012
Source: (Liver disease biggest cause of alcohol-related deaths in England and Wales. 2014)

With the help of above picture it is evaluated that age of 45-54 years old people had the
highest number of admission among which number of males were high as compare to females.
A.9 Describe long term and more recent trends
The long term trend shows a significant growth in the alcohol related liver diseases. The
people have been consuming alcohol for a long time and it damages the functions of the liver.
This give rise to the diseases. The number of males are more than females in the death rate. The
reason behind this is that males consume more alcohol than females. But in England a significant
rise can be seen in the female drinking population as well. Both of them combined together has
been given lot of problems to the government as it is expected to grow at a rapid pace in future
(Alcohol related health risks. 2016).
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Illustration 4: Alcohol related NHS hospital admission in England 2013/14
Source: (Statistics on Alcohol England. 2015)

Illustration 5: Alcohol related deaths in England by gender
(Source:Health problem associated with alcohol, 2012)
TASK- PART B
Over the last five years it has been observed that alcohol related admissions were very
high and by year it is continuously increasing. At the local path the admissions are increased, so,
it is very essential to find the better solutions in order to resolve this problem. The reason is
every age person in England mostly prefers to consume alcohol at daily manner. In this, few
intervention initiatives are defined below which are as follows:
Medical treatments- In this use of cortico steroids is used in therapy to motivate a persona. In
this, trainings are provided in both long term and short term. In this, patients can use the anti
alcoholic addiction medications (Sookoian, Castaño and Pirola, 2014).
Care and support- In order to improve the medical health conditions of already admitted patients
who are suffering form alcoholic liver disease. They essentially requires the care and support
from family, friends and surrounding people. In this context, proper meditation and therapies are
required so that they can prevent the alcohol consumption. Further, there are also few therapies
are present which helps in reducing the harmful effects of drinking. The therapies like nutrition
therapy, pharmacological therapy, anti cytokine therapy and combination therapy etc. These
therapies helps in improving the functioning and result of scarring degree in liver (Lazo and
et.al., 2013). Along with this there also digital interventions are present that helps in reducing
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harmful and hazardous consumption in population of UK. By using the digital interventions,
population van be motivated to reduce their alcohol consumption. In this few methods are
included such as personalised feedback, facer to face interaction etc. in this it is important for
health care experts and nurses of primary care to provide the interventions. In addition to their
many mobile applications are present to measure the consumption rate of alcohol. By
maintaining the records, affected people can keep an eye which will motivate and influence them
to stop consuming alcohol in excessive manner. Further, for the establishment of face to face
interaction, Skype and other options are present. By using this health experts and nurses can
guide their patients (Singal and et.al., 2013).
At the time of establishing the digital intervention related services, various challenges
and merits are linked with this. In this challenges like lack of awareness among people about
digital application, lack of knowledge about harmful affects of alcohol on body and uses of
tradition which influence to not to relies on new technologies. In this, at the time of
implementing the intervention, proper training should also be given to caring roles and health
assistants. So that they can provide effective care and support services to patients. Along with
this it is also very important to provide the knowledge about how to use the digital application to
local public so that they can motivate to use the applications like alcohol tracker etc. At the time
of using one time computer based screening methods, the problems occurs like patient does not
motivate to use any new technology etc. In this health care professionals are required to motivate
the patient to quit drinking (Mathews and et.al., 2014).
Summary
 The above research helps in articulating that health informatics plays and important role
in health and social care sector.
 The research defines that over consumption of alcohol leads to liver diseases. This type
of problem is facing by many counties in which present research defines the statics of
England.
 It helps in understanding that over consumption and misuse of alcohol is very harmful
because it directly affects the functioning of liver.
 It is evaluated that
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REFERENCES
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Sookoian, S., Castaño, G.O. and Pirola, C.J., 2014. Modest alcohol consumption decreases the
risk of non-alcoholic fatty liver disease: a meta-analysis of 43 175
individuals. Gut. 63(3). pp.530-532.
Lazo, M., and et.al., 2013. Prevalence of nonalcoholic fatty liver disease in the United States:
the Third National Health and Nutrition Examination Survey, 1988–1994. American
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Singal, A.K. and et.al., 2013. Evolving frequency and outcomes of liver transplantation based on
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