| What are the findings of alcohol use on the liver? | Broad spectrum of symptoms according to consumption, ranging from asymptomatic to fatty liver and end-stage liver failure (jaundice, coagulopathy and encephalopathy)
Moderate alcohol intake can cause vasodilation which is a cardiovascular benefit this makes the french paradox (less cardiovascular disease due to combination of alcohol and fat intake)
It comes with socio-physical problems |
| What is the percentage of alcohol intake inducing liver cirrhosis? | For females: 20-40 g/day for males:60-80 g/day for over 10 years
But may differ among individuals (only 10% of alcoholics will develop liver cirrhosis (acc to genetics, obesity (causing NASH), past hx, medications...)
This quantity of alcohol intake is 1 L of wine or 8 beers. |
| Talk about the epidemiology of alcoholic liver disease. | One of the leading causes of global burden of disease and injury, it is the most widely abused substances worldwide
100,000 deaths/year is US, causes other conditions (psychotic, cardiomyopathy, amnesic syndrome, liver disease)
In US it is the leading cause of death due to liver failure (in lebanon second cause)
*it is a chronic disease - reliant in ethanol. |
| What are the percentages of alcohol in beverages? | Beer: 5%, wine: 12%, hard liquor (whiskey...): 40%
But portions of consumed alcohol are practically the same (14g / serving)
Regardless of type of alcohol consumed, more alcohol = more progressive disease.
man <4 drinks/day or 14/week, woman <3/day or 7/week. |
| Talk about the risk of development of alcoholic liver disease. | over 90% get liver steatosis, 10% get hepatitis.
Risks of the disease are amount consumed, genetics, sex (female increased risk), obesity, chronic viral hepatitis, nutritional impairment and drugs intake |
| How does the liver metabolize alcohol? | Liver is principal alcohol metabolising organ, as ethanol is rapidly absorbed by the upper GI, it diffuses to liver via portal vein, then alcohol dehydrogenase degrades it converting it into acetaldehyde (affecting protein synthesis) damaging hepatocytes (excess free radicals) this excess leads to inability to prevent and repair damage + kupfer cell activated leading to hepatocellular death -->fibrosis. |
| What are the PE findings in alcoholic liver disease? | Acc to stage (normal, cirrhotic or decompensated)
Ascites, clubbing, jaundice, neuropathy, palmar erythema.
Most important pathogneomonic sign is Dupuytren's contraction (seen when hand shake) |
| What are the lab findings in alcoholic liver disease? | AST/ALT ratio >2 (both elevated) but less than 500
macrocytic anemia (increased MCV), leukocytosis (inflammation), increased bilirubin |
| What are all the liver consequences of alcoholism? | 90-100% of time leads to steatosis (fatty liver) which may lead to cirrhosis if no alcohol abstaining.
Can also lead to acute hepatitis where frequent repeated attacks may also lead to cirrhosis.
Acute hepatitis and steatosis are reversible (by abstaining from alcohol) while cirrhosis isn't (unless in very early stages) |
| What is hepatic steatosis? | Fatty liver, not exclusive for ALD.
accumulation of TGs in hepatocytes, 90-100% of heavy drinkers have it, short term exposure to over 80g/day for several days may cause it.
Reversible, no clinical symptoms (maybe hepatomegaly), normal liver test or elevated.
it occurs due to macrovesicular fatty infiltrate, can be due to other causes than alcohol (starve, pregnancy, drug, viral hep, Reye...) |
| What is alcoholic hepatitis? | Fatty liver + hepatitis (steatohepatitis), precursor of cirrhosis.
results from alcohol abuse, can be subclinical.
40% of them will lead to cirrhosis within 1-2 years
Clinically its heavy alcohol intake with lab findings (viral/ use drugs..)
Presents Asymptomatic - majority, or symptomatic liver failure
Elevated ALP, gGT, bilirubin, CRP, ESR needs urgent treatment (corticosteroids for 3 weeks)
Obligatory: liver cell necrosis, mallory body, neutrophil infiltrate, perivenular inflammation |
| What is alcoholic cirrhosis? | Irreversible, 50g/day alcohol intake for 10 years causing it, both steatosis and hepatitis and fibrosis, if unchecked makes hepatic fibrosis.
May be micronodular (chronic) or macronodular (acute) or mixed.
Similar to normal cirrhosis but increased ration of AST/ALT
Needs long-term management (abstinence, nutrition, liver transplant urgent |
| An alcoholic patient comes with epigastric pain, what is the differential ? | Acute pancreatitis due to alcohol, we confirm it by lipase test |
| An alcoholic pt presents with jaundice, what is the course of action? | LFT (Bi, ALT, AST, gGT, ALP, INR, ALB), CBC, Virals serology (for hep B and C) |
