Alchoholic liver disease pathophysiology

1. Alcoholic liver disease
Pharmacotherpeutics

2. Introduction
• Chronic and excessive ingestion of alcohol is one the major causes of
liver disease.
• Excessive ingestion of alcohol might lead to several liver diseases such as
alcoholic hepatitis, fatty liver, cirrhosis.
• Many people usually don’t develop any symptom in early stage.
• Major problem with low socio economic people.

3. • Consumption of 75-100ml per day for 20 yrs for men and 25ml per day
for women will significantly increase risk of liver damange.
• Fatty liver is present in >90% of daily as well as binge drinker.
• Accumulation of fat within hepatocyte due to acetyl dehydrogenase
causes fatty liver
• 10-20% alcoholic will develop hepatitis.

6. Pathophysiology

8. Clinical features
• Symptom depend on severity of damage in liver.
• In early stage there might not be any remarkable symptom. How ever
symptom tend to be worsen after chronic and heavy ingestion.
• G.I symptom: pain and swelling in abdomen, decrease in appetite,
weight loss, dry moth, increase thrust,
• Skin problem: Jaundice, dryness, itching.
• CNS: Problem with thinking, memory, headache

9. Investigations
• LFT: Elevation (2-7 times) ALT, AST, gGT.
• USG of liver
• Liver biopsy
• Other test…?

10. Complications
• Portal hypertension
• Varices(G.I bleeding)
• Ascites(fluid accumulation in peritoneal cavity)
• Hepatic encephalopathy.

11. Management
• Non pharmacological
• Remove offending material i.e alcohol.
• Bed rest,
• sodium restriction.
• Diet: Increase protein, vitamin A,D, thiamine, pyridoxine, zince
Surgical: Liver transplant

12. Pharmacological management
• Specific treatment according to clinical features and complications.
• Cirrhotic ascites:
• Diuretics: Spironolactone (100-400 mg/day), Frusemide (40-160mg/day)
• Hepatic encephalopathy: Lactulose,(15-40 ml BD/TDS), rifaxamin
(400mg TDS)
Hepatitis: Corticosteroid: Prednisolone: 40 mg daily
• Other medicines:
• Silymarin: Antioxidative and anti fibrotic property. Dose 140 mg
bd/TDS
• Pentoxyfylline: antioxiidative property,decreases cytokinine

13. • Self study: Fulminant hepatitis.