This document discusses alcoholic liver disease and its pharmacotherapeutic management. It notes that chronic excessive alcohol ingestion can lead to conditions like fatty liver, alcoholic hepatitis, and cirrhosis. Symptoms may not appear initially but worsen with continued heavy drinking and include abdominal pain, weight loss, jaundice, and cognitive issues. Investigations show elevated liver enzymes. Complications include portal hypertension, varices, ascites, and hepatic encephalopathy. Management involves removing alcohol, diet changes, medications like diuretics for ascites, lactulose for encephalopathy, corticosteroids for hepatitis, and antioxidants like silymarin. Liver transplant is an option for severe cases.

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.