Alcoholic Liver Disease (ALD) #Steatosis (Fatty Liver) #Alcoholic Hepatitis #Cirrhosis

1. ALCOHOLIC LIVER DISEASE
Ariiq Azmi Rofiqi Sulkhan

2. Alcoholic liver disease (Ald)
Alcoholic
Hepatitis
Cirrhosis
Decompensated
Liver Disease
Hepatocellular
Carcinoma
90-100%
10-35% 8-20%
40%
3-10%20-40%
Normal Liver Fatty Liver
(Pal and Rai, 2016)
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3. PAThOPHYSIOLOGY
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4. PAThOPHYSIOLOGY3

5. PAThOPHYSIOLOGY
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6. PAThOPHYSIOLOGY5

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8. PAThOPHYSIOLOGY7

9. PAThOPHYSIOLOGY
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10. investigation
1. CAGE test (screening for alcohol abuse)
2. Clinical Picture
C. Have you ever felt the need to cut down your drinking?
A. Have you ever felt annoyed by criticism of your drinking?
G. Have you ever felt guilty after drinking?
E. Have you ever taken a drink (eye opener) first thing in the morning?
Steatosis Alcoholic Hepatitis Cirrhosis HCC
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11. investigation
Steatosis
fat deposit = steatosis
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12. investigation
Alcoholic Hepatitis
swollen hepatocytes
containing Mallory
body
Mallory body
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13. investigation
Cirrhosis
nodule surrounded
by fibrous tissue
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14. investigation
Hepatocellular Carcinoma
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15. investigation
3. Laboratory Test
- Aspartate Aminotransferase (AST) = >500 IU/L (n : 0-35 IU/L)
- Alanine Aminotransferase (ALT) = mildly elevated (n : 0-45 IU/L)
- AST/ALT ratio = >2 (n < 1)
- Mean corpuscular volume (MCV) = >100 fL/cell (n : 80-97 fL/cell)
- Carbohydrate deficient transferrin (CDT) = >1,7% (n < 1,3%)
- Gamma-glutamyl transpeptidase (GGT) = >30 IU/L
- Serum alkaline phospatase (ALP) = >160 IU/L
- Serum bilirubin (hyperbilirubinemia) = >1,3 mg/dL
- Prothrombine time = >12 sec
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16. MANAGEMENT
1. Abstinence from alcohol
2. Nutritional support
3. Glucocorticoid
4. Pentoxifylline
5. Glucocorticoid + Pantoxifylline
6. Granulocytes colony (GMA)
7. Liver transplantation (LT)
- Disulfirum (poor)
- Naltrexone
- Baclofen
- N-methyl-D-aspartate
Steatosis (Fatty Liver)
Alcoholic Hepatitis
Cirrhosis
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17. SUMMARY
Steatosis (Fatty Liver) Alcoholic Hepatitis Cirrhosis
Points the status is reversible with
abstinence
necroinflammation development
along with steatosis
the stage is irreversible and cause
liver failure and cancer
Clinical Findings asymptomatic jaundice, hepatomegaly ascites, vascular spiders, palmar
erythema, gynecomastia, parotid
and lacimal gland enlargement
Images (CT, US) fatty infiltration significant hepatomegaly, focal or
massive necrosis
cirrhotic changes, atrophic liver,
nodular lesion, tumor
Histology micro- and macro- vesicular fat
accumulation within hepatocytes,
no fibrosis
fibrosis, swollen hepatocytes,
amorphous eosinophillic Mallory
bodies surronded by neutrophils,
necrosis, steatosis
liver fibrosis,
micronodular and may gradullay
transform ro macronodular
cirrhosis
Therapeutic abstinence, nutritional support corticostreroids, pentoxiflylline,
GMA, LT
LT
CT : Computed Tomography
US : Ultrasonography
GMA : Granulocytes / Monocytes Apheresis
LT : Liver Transplantation
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18. THANK YOU !

20. PAThOPHYSIOLOGY

21. OTHER