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ALCOHOL LIVER DISEASE.pdf
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- 2. OVERVIEW • Introduction • Etiopathogenesis •Clinical Features • Diagnosis • Prognosis • Treatment
- 3. 3 © Medi -Lectures Dr Shubham Upadhyay
- 4. 4 © Medi -Lectures Dr Shubham Upadhyay
- 5. INTRODUCTION • Responsible for50% of mortality from all cirrhosis • Pathology consists 3 major lesions: 1. Fatty Liver 2. Alcoholic Hepatitis 3. Cirrhosis • World’s 3rd largest risk factor for disease burden • Most of the mortality fue to ALD is secondary to cirrhosis
- 6. ETIOLOGY & RISKFACTORS • Most imp. risk factors- Quantity & Duration of alcohol intake • 1 beer= 4 ounces wine = 1ounce spirit(80%) = 12 gm alcohol
- 8. PATHOGENESIS • Alcohol Metabolism •Gastric • Hepatic • Alcohol- Direct Hepatotoxin • Inflammatory Cascade after metabolism of alcohol
- 9. PATHOGENESIS • Alcohol Metabolism •Gastric • Hepatic • Alcohol- Direct Hepatotoxin • Inflammatory Cascade after metabolism of alcohol • Steatosis - fatty acid synthesis, ↓ fatty acid oxidation • Intestinal derived Endotoxin • Lipopolysaccharide hepatic influx, intestinal microbiome dysbiosis
- 10. PATHOGENESIS • Alcohol Metabolism •Gastric • Hepatic • Alcohol- Direct Hepatotoxin • Inflammatory Cascade after metabolism of alcohol • Steatosis - fatty acid synthesis, ↓ fatty acid oxidation • Intestinal derived Endotoxin • Lipopolysaccharide hepatic influx, intestinal microbiome dysbiosis • Protein aldehyde adducts, Reducing equivalents, oxidative stress • Kupffer cell, Stellate cell activation & Collagen production • Micronodular Cirrhosis
- 11. PATHOLOGY • Fatty Liver- Initial & most common histologic response to hepatotoxic stimuli • Alcoholic Hepatitis • Cirrhosis- present in 50% of patients with biopsy proven alcoholic hepatitis
- 12. CLINICAL FEATURES • FattyLiver • Usually Asymptomatic • Rt. hypochondrial pain, Nausea, Jaundice • Alcoholic Hepatitis • Wide spectrum • Portal HTN, ascites, variceal bleeding can occur
- 13. CLINICAL FEATURES • FattyLiver • Usually Asymptomatic • Rt. hypochondrial pain, Nausea, Jaundice • Alcoholic Hepatitis • Wide spectrum • Portal HTN, ascites, variceal bleeding can occur • Cirrhosis • Non specific symptoms • Ascites, Edema, UGI bleed, jaundice, encephalopathy • Physical Examiination • Icterus, Palmar erythema, spider angiomas, parotid enlargement, clubbing, ms wasting • Male vs Females • Palpations- Hepatomegaly, splenomegaly with firm, nodular edge of liver • End stages- Shunken Liver
- 14. LABORATORY FEATURES • FattyLiver • Non specific elevtaion of AST, ALT, GGTP • Hypertriglyceridemia, Hyperbilirubinemia • USG- Fatty infiltration • Alcoholic Hepatitis • AST, ALT elevated 2 to 7 folds , usually <400 IV with AST:ALT ratio >1 • Modest elevation of ALP • Advanced disease- Hypoalbuminea, Coagulopathy • USG- Fatty Infiltration. Presence of PV flow reversal, ascites, intraabdominal venous collaterals indicates serious liver injury
- 16. • Cirrhosis • EarlyCompensated- Normal lab values • Anemia • Thrombocytopenia • S. Bilirubin • Prothrombin Time • s. Na+ • AST:ALT ratio: 2:1 • USG: Shunken, fibrosed liver
- 17. PROGNOSIS • Critically illpatients with alcoholic hepatitis • Severe alcoholic hepatitis • Coaguopathy • Anemia • Hypoalbuminemia • Hyperbilirubinemia • Renal Failure • Ascites • Discriminant Function • MELD score • Poor Prognosis - Ascites, variceal hmg, encephalopathy, heptaorenal syndrome • 5 yr survival in cirrhotics who continue to drink?
- 18. TREATMENT • Complete Abstinencefrom Alcohol • Glucocorticoids • Prednisolone • DF>32 or MELD>20 • C/I • Pentoxiphylline • Avoidance of concomitant hepatotoxic drugs • Liver Transplantation