Alcoholic liver disease is a term that encompasses the hepatic manifestations of alcohol overconsumption, including fatty liver, alcoholic hepatitis, and chronic hepatitis with hepatic fibrosis or cirrhosis.

1. CASE PRESENTATION
ON
ALCOHOLICLIVER CIRRHOSIS
Presented by
MAKBUL HUSSAIN CHOWDHURY
Pharm. D 4th YEAR
ANURAG PHARMACY COLLEGE

2. LIVER
 Liver is one of the largest organ in our body weighs up
to 1500 grams in adults.
 With the exception of the brain, the liver is the most
complex organ in the body.
 And it has more than 500 different vital functions in
our body.
 Some of the more well-known functions include the
following:
Production of bile, which helps carry away waste and
break down fats in the small intestine during digestion

3. ALCOHOLIC LIVER CIRRHOSIS :
Alcoholic liver disease is a term that encompasses the hepatic manifestations of alcohol
overconsumption, including fatty liver, alcoholic hepatitis, and chronic hepatitis with hepatic fibrosis
or cirrhosis.
Primary histologic features:
1. Marked fibrosis
2. Destruction of vascular & biliary elements
3. Regeneration
4. Nodule formation

4. STAGES OF ALD :
There are three main stages of alcoholic liver disease, although there is often an overlap between
each stage. The three stages are explained below.
Alcoholic fatty liver disease
• Alcoholic fatty liver disease is the first stage of alcoholic liver disease.
• Drinking a large amount of alcohol, even for only a few days, can lead to a build-up of fatty
acids in the liver.
• Fatty liver disease rarely causes any symptoms but it is an important warning sign that you are
drinking at a level that is harmful to your health.
• Fatty liver disease is reversible.
Alcoholic hepatitis
• Alcoholic hepatitis (not related to infectious hepatitis) is the second, more serious stage of
alcoholic liver disease.

5. • Prolonged alcohol misuse over many years can cause the tissues of the liver to become inflamed.
This is known as alcoholic hepatitis. Less commonly, alcoholic hepatitis can occur if you drink a
large amount of alcohol in a short period of time (binge drinking).
•Alcoholic hepatitis is usually reversible, although you may need to stop drinking alcohol for
several months or years.
Cirrhosis
• Cirrhosis is the final stage of alcoholic liver disease. Cirrhosis happens when prolonged
inflammation causes scarring of the liver and loss of function. Loss of liver function can be life
threatening.
• The damage caused by cirrhosis is not reversible. In mild to moderate cases, stopping drinking
alcohol immediately should prevent further damage and lead to the gradual recovery of liver
function. In more severe cases, a liver transplant may be required.
Epidemiology :
• In India, liver cirrhosis is one of the leading cause of death .
• 12th leading cause of death in the united states

6. •On average about 27,000 deaths per year
• 40% cases asymptomatic
• Additional 10,000 deaths due to liver cancer secondary to cirrhosis Overall, alcoholic liver disease
accounts for well over a third (37%) of liver disease deaths. And figures show victims of liver
disease are getting younger – more than 1 in 10 of deaths of people in their 40s are from liver
disease, most of them from alcoholic liver disease
Etiology of liver cirrhosis
• Hepatitis C, fatty liver, and alcohol abuse are the most common causes of cirrhosis of the liver.,
but anything that damages the liver can cause cirrhosis, including:
• Fatty liver associated with obesity and diabetes
• Chronic viral infections of the liver (hepatitis types B, C, and D; Hepatitis D is extremely rare)
• Blockage of the bile duct, which carries bile formed in the liver to the intestines, where it helps in
the digestion of fats; in babies, this can be caused by biliary atresia in which bile ducts are absent or
damaged, causing bile to back up in the liver. In adults, bile ducts may become inflamed, blocked,
or scarred, due to another liver disease called primary biliary cirrhosis.

7. Risk Factors :
• Quantity of alcohol taken: Consumption of 75–100 ml/day for 20 years or more in men, or 25
ml/day for women significantly increases the risk of hepatitis and fibrosis by 7 to 47%
• Pattern of drinking: Drinking outside of meal times increases up to 2.7 times the risk of
alcoholic liver disease.
• Gender: Females are twice as susceptible to alcohol-related liver disease, and may develop
alcoholic liver disease with shorter durations and doses of chronic consumption. The lesser amount
of alcohol dehydrogenase secreted in the gut, higher proportion of body fat in women, and changes
in fat absorption due to the menstrual cycle
• Genetic factors: Genetic factors predispose both to alcoholism and to alcoholic liver disease.
Monozygotic twins are more likely to be alcoholics and to develop liver cirrhosis than dizygotic
twins

8. • Diet: Malnutrition, particularly vitamin A and E deficiencies, can worsen alcohol induced liver
damage by preventing regeneration of hepatocytes. This is particularly a concern as alcoholics are
usually malnourished because of a poor diet, anorexia, and encephalopathy.
Signs
• Bleeding tendencies : deficiency of clotting factors
• Hyper pigmentation
• Hyper dynamic circulatory state
• Edema
• Hernia
Digestive symptoms include:
• Pain and swelling in the abdomen
• Decreased appetite and weight loss
• Nausea and vomiting
•Fatigue

9. Skin problems such as:
• Yellow color in the skin, mucus membranes, or eyes (jaundice)
• Small, red spider-like veins on the skin
• Very dark or pale skin
• Redness on the feet or hands
Itching Brain and nervous system symptoms include:
• Problems with thinking, memory, and mood
• Fainting
• Numbness in legs and feet
Diagnostic tests
• Complete blood count (CBC)
• Liver biopsy
• Liver function tests
•Abdominal CT scan

10. Case Study
A 70 years old male patient was admitted in the hospital on 10/11/18
Chief Complaints :
C/o: abdominal distention since 4days weakness since 15days decreased appetite since 15days
weight loss since 15days
On Examination : Patient is conscious and oriented
No cyanosis/icterus/clubbing
B.P-120/80 mm Hg , RR-20 b/m
PR- 80b/m CVS-S1,S2 +ve
Patient Medical History : Not a k/c/o : HTNBADM
Past Medication History : Not available

11. Social History : Alcoholic, Smoker, Belongs to low economic status, Married , Non-Allergic
Lab Investigations
BLOOD TEST
Content Value Normal Value
Hb 12g/dl (↓) Men- 13-17 g/dL
Women-12-15 g/dL
RBC 3.2 M/micro L (↓) M- 4.7 to 6.1 million cells/ mcL
W-4.2 to 5.4 million cells/mcL
WBC 6700 /mm3 4,500 to 11,000/microliter
ESR 24mm/hr(↓) M -0-22 mm/hr
W- 0-29 mm/hr

12. Lab Reports
LIVER FINCTION TEST
Content Value Normal Value
SGOT 169 microL (↑) 5 to 40 units /liter
SGPT 162 microL (↑) 7 to 56 units /liter
ALP 78 microL (↑) M-20–70 U/L
W-20–150 U/L
Albumin 3.1 gm/dl (↓) 3.8–5.0 g/dl
Globulin 21gm 2.0 to 3.5 gm/dl

13. RENAL FUNCTION TEST
Special investigations
US Abdomen : coarse texture
Gall Bladder : wall thickening
Spleen : enlarged mass
Diagnosis : Alcoholic liver cirrhosis
Content Value Normal Value
BUN 12mg/dl 8–23 mg/dL
Sr.Cr- 0.7mg/dl 0.6–1.2 mg/dl

14. Sl.
No
Drug Name ROA Frequency Duration
10 11 12 13
1 Inj. Monocef (1g)
(cephalosporin–antibiotic )
IV BDS Y Y - -
2 T. Udiliv(600mg)
(ursodeoxycholic acid)
PO TDS - Y Y -
3 Tab. Hepameez(10mg)
(L-ornithine+ L-aspartate)
IV OD Y Y Y Y
4 Inj.Metronidazole(160mg)
(anti-eleminthic)
PO OD - Y - -
5 Syp. duphalac (2tsp)
(Bisacodyl – laxative)
IV SOS Y Y Y Y
6 Inj. Amikacin(250mg)
(Antibiotic)
PO BD - - Y Y
7 Inj. pantoprazole(40mg)
(proton pump inhibitors)
IV BD Y Y Y Y