Alcoholic liver disease

Clinical features

Fatty liver:

Often assymptomaticMay have vague abdominal symptoms:NauseaVomitingDiarrhoeaThese are more likey due to GI effects ofalcoholHepatomegaly may be present as may othersigns of chronic liver disease

Alcoholic hepatitis:

Varibiable: mild symptoms with hepatitis only beingapparent on biopsy

Mild-moderate symptoms e.g mild jaundice,pruritis, fatigue. Dx is made on liverhistology.

Severe cases the patient is ill with jaundice,ascites, abdominal pain, & a high feverassociated with liver necrosis. O/Ehepatomegaly, jaundice, splenomegaly,ascites, ankle oedema

Alcoholic cirrhosis:

Represents final stage of liver disease.O/E hepatomegaly, jaundice, splenomegaly,ascites, ankle oedema

Management

General:

Stop drinkingChlordiazepoxide 'detox regime'. (forwithdrawl)IV thiamine {pabrinex 1+2} (preventwernicke-korsakoff)Vitamin & protein suplements (contained inpabrinex)SupportConsider anti-depressantsConsider disulfiram (unpleasant symptomsif alcohol consumed)

Fatty liver:

Advise to stop drinking

Alcoholic hepatitis:

Advise to stop drinkingTx encephalopathy & ascitesNG tube for feedingVit B&C IMCorticosteroids (only if no infection present)

Alcoholic cirrhosis:

There is no treatment available to reversecirrhosis.Management is aimed at that to deal withthe complications of decompensatedcirrhosis.Lifestyle - avoid aspirin & NSAIDs, avoidalcohol, reduced salt intake.Monitoring - 6-monthly USS & serum alpha-fetprotein to detect development of HCC.Transplant as a last resort.

Complications:

Portal hypertensionAscites

Portosystemic encephalopathyRenal failure

HCCInfection

Malnutrition

Prognosis

Fatty Liver:

I if patient abstains from alcohol then fatwill disappear and LFTs return to normal.

Alcoholic hepatitis:

Prognosis is variale.Despite abstinence disease may beprogressive.50% mortality in severe cases.If PT > 2x normal, encephalopathy, & renalfailure then 90% mortality.

Alcoholic cirrhosis:

90% survival at 5 years with abstinence60% with continued drinkingIf jaundice, ascites, haematemesis then 35%survival

Pathology

Fatty change:

Metabolism of alcohol produces fat in theliver (zone 3).Effect minimal with small amounts butsteatosis (cells swollen with fat) occurs withlarge amounts.Gives swiss cheese effect on haematoxylinand eosin stain.Also seen in:ObesityDiabetesThere is no permanent cell damage and fatdisappears on stopping alcohol

Alcoholic hepatitis:

In addition to fatty change there isleucocyte infiltration and hepatocytenecrosis (zone 3)If consumption is maintained then cirrhosismay develop

Alcoholic cirrhosis:

Classically micronodular cirrhosisacompanied by fatty change and evidenceof pre-existing alcoholic hepatitis

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