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Alcoholic liver disease

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Alcoholic liver disease Alcoholic liver disease Presentation Transcript

  • Alcoholic Liver Disease
    © Freelance Genius 2010
  • Introduction
    Alcohol is a common cause of chronic liver disease.
    Alcohol consumption is well-entrenched in the fabric of many cultures
    Less than 20% of heavy drinkers progress to advanced disease.
    Alcoholic liver disease presents as fatty liver, hepatitis or Laennec cirrhosis.
  • Epidemiology
    There is a rising incidence in developing countries
    Alcoholic liver disease does not occur below a threshold of 21units/wk in women and 28units/wk in men.
    Average alcohol consumption of an individual with cirrhosis is 160g/day for an average of 8 years.
    There is no clear cut relationship between dose and disease
  • Significant consumption
    Significant alcohol consumption varies with gender.
    More than 24g/day in males and more than 21g/day in females is significant.
  • Risk factors
    Genetic
    Susceptibility genes- genes involved in alcoholic metabolism, TNF-α, IL-10
    Environmental
    Drinking pattern
    Gender
    Nutrition- Choline deficient diet, caffeine and coffee
    Co-morbidity
    HCV
    Obesity
    Hemoochromatosis
  • Alcohol type and %
  • Ethanol metabolism
    Alcohol is metabolized by two pathways:
    Alcohol and acetaldehyde dehydrogenases
    DHs increases generates NADH/NAD ratio
    Mixed function oxidase enzyme
    They generate free radicals
    Alcoholic effects on the liver
    Increased fatty acid synthesis
    Altered metabolism of proteins and CHOs
    Stimulates stellate cells
  • Pathogenesis
    10-15% of heavy alcoholic drinkers develop liver disease.
    Why?
    Acetaldehyde-protein adducts
    Oxidative stress
    Gut permeability
    Cytokines-Endothelin
  • Pathology
    Fatty liver
    Lipogranuloma
    Macrovesicular steatosis
    Swiss cheese effect on haematoxylin and eosin stain
    Alcoholic hepatitis
    Neutrophil infiltration
    Mallory’s hyaline
    Pericellular fibrosis
    Cirrhosis
    Micronodular type
    Central hyaline sclerosis
  • Clinical features
    ALD is a spectrum.
    Fatty liver
    +/- symptom
    Abnormal LFTs
    Normal/large liver
    Alcoholic hepatitis
    Symptomatic
    Jaundice
    Malnutrition
    Hepatomegaly
    Features of portal hypertension
  • Cirrhosis
    Peripheral stigmata of CLD
    Jaundice, finger clubbing
    Hepatomegaly, ascites
    Circulatory changes
    Endocrine changes
    Hematological tendency
    Portal hypertension
  • Differential diagnosis
    Non-alcoholic steatohepatitis
    Chronic viral hepatitis
    Immune –autoimmune liver disease
    Biliary
    Primary biliary cirrhosis
    Genetic
    Haemochromatosis
    Alpha-antitrypsin deficiency
    Cryptogenic
  • Investigation
    Establish alcohol misuse
    Blood tests
    FBC-macrocytosis
    LFT-elevated GGT, bilirubin and ALP
    EUC
    Markers
    Imaging
    Abdominal USS
    Chest Xray
    Liver biopsy
  • Treatment
    Stop alcohol!
    Nutritional support
    Corticosteroids
    Anti-TNF-α
    Liver transplant
  • Complications
    W-K encephalopathy
    Hepatic coma
    Massive GI bleeding
    Intercurrent infection
    Hepatorenal syndrome
    HCC
  • Conclusion
    Minimize alcohol consumption, stop it if side effects are obvious.