Alcoholic liver disease, definition, etiology, pathogeneisis, clinical manifestations, pharmacological and non pharmacological treatments. Useful for students of Diploma in pharmacy and B.Pharm.

1. GASTRO-INTESTINAL
DISORDERS
ALCOHOLIC LIVER DISEASE
A PRESENTATION BY
AMAN KUMAR
LECTURER
GCRG COLLEGE OF PHARMACY

2. ALCOHOLIC LIVER DISEASE
• As the name implies, alcoholic liver disease is liver injury which occurs due to
excessive alcohol use.
It includes:
• Alcoholic Fatty liver (Steatosis= accumulation of fat in tissue);
• Alcoholic hepatitis and;
• Chronic hepatitis with liver fibrosis (accumulation of scarred tissue/damaged
tissue in liver) or cirrhosis.
Definition:
Alcoholic liver disease is a result of over consumption of alcohol that damages the liver,
leading to a build up of fats, inflammation, and scarring (tissue damage/wound).
Over consumption of alcohol [Consumption of about 75-100 ml/day in men &
consumption of about 25 ml/day in women for 20 years or more ]
Fatty liver; Alcoholic hepatitis; Fibrosis or Cirrhosis
ALCOHOLIC LIVER DISEASE

3. Healthy Liver Alcoholic fatty liver (Steatosis) Alcoholic
hepatitis Liver fibrosis Liver cirrhosis.

4. ETIOLOGY OF ALD
Alcoholic liver disease is caused by drinking excessive alcohol for longer
duration. Drinking a large amount of alcohol in a short amount of time can
cause fatty liver disease and less commonly, alcoholic hepatitis.
There are some risk factors responsible for ALD:
• Quantity of alcohol taken: Consumption of 60-80 g of alcohol per day
(about 75-100 ml/day) for 20 years or more in men or 20 g/day (about 25
ml/day) for women can cause liver damage.
• Pattern of drinking: Drinking outside of meal times increases up to 3 times
the risk of alcoholic liver disease.
• Gender: Women are twice as susceptible to alcohol-related liver disease and
may develop alcoholic liver disease with shorter durations and doses of
chronic consumption.
• Hepatitis c infection: Hepatitis c infection significantly accelerates the
process of liver injury.
• Genetic factors: Genetic factors increases risk to both to alcoholism and to
alcoholic liver disease.
• Diet: Malnutrition, particularly vitamin A and E deficiencies can worsen
alcohol-induced liver damage by preventing regeneration of hepatocytes.

5. PATHOPHYSIOLOGY OF ALD
Overconsumption of Alcohol
Higher NADH concentration induces fatty acid synthesis.
Fatty acid thus formed leads to Alcoholic fatty liver (Steatosis).
Continued alcohol use will lead to liver inflammation and swelling known as Alcoholic hepatitis.
Continued usage will lead to Liver Fibrosis[tissue damage/scarring].
If alcohol usage is still continued, Fibrosis will change into Liver Cirrhosis[scarred tissue becomes
hard and liver stops functioning.
[Note:ADH=Alcohol dehydrogenase; ALDH=Aldehyde dehydrogenase; NAD= Nicotinamide adenine
dinucleotide; NADH= nicotinamide adenine dinucleotide hydrogen .]
Alcohol Acetaldehyde Acetate
NAD+ NADH NAD+ NADH
ADH ALDH

6. CLINICAL MANIFESTATIONS OF
ALD
The most common sign of alcoholic hepatitis is yellowing of
the skin and eyes (jaundice).
Other signs and symptoms include:
• Loss of appetite.
• Pain in the abdomen.
• Nausea and vomiting.
• Abdominal tenderness.
• Fever, often low grade.
• Fatigue and weakness.
• Malnutrition is common in people with alcoholic hepatitis.
• Weight loss.

7. DIAGNOSIS OF ALD
• Liver Function Tests: These tests are simple, inexpensive and
easy to perform.
• Imaging Tests: An ultrasound scan, CT scan can also be
carried. These scans produce detailed image of liver.
• Liver Biopsy: A fine needle is inserted into the body and a
small sample of liver cell is taken under local anaesthesia and
is examined under microscope.
• Endoscopy: An endoscope is a thin flexible tube with a light
and video camera at one end. This tube is passed into
oesophagus and stomach and examine for infection.

8. TREATMENT OF ALD
NON PHARMACOLOGICAL TREATMENT:
• Alcohol Abstinence: Abstinence is the most important therapeutic
intervention for patients with ALD.
• Consuming Nutritional Diet
PHARMACOLOGICAL TREATMENT:
Different types of drugs are used for ALD:
• Prednisolone: It can lower liver inflammation.
• Folic Acid (Vit B9): Folic acid can also inhibit liver inflammation.
• Thiamine (Vit B1): To supply vitamin B1 as alcohol causes
malabsorption of Vit B1.
• Ergocalciferol (Vit D): Helps in reducing liver cell damage.
• Vitamin E: Acts as antioxidant and prevents cell damage.
• Silymarin (Silybum marianum; Milk thistle): It prevents liver cells
from alcohol toxicity.

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