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Alcoholic liver disease: Difference between revisions
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(Created page with "Alcoholic liver disease (ALD) is an umbrella term for liver conditions caused by significant and chronic alcohol abuse. It initially causes liver steatosis, which progresses to alcoholic hepatitis to cirrhosis unless alcohol consumption stops. Almost all who abuse alcohol develop liver steatosis, which is reversible, but only a few progress to hepatitis and cirrhosis. Hepatitis C is often found in chronic alcoholics and leads to acceleration of alcoholic liver d...") |
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Alcoholic liver disease (ALD) is an umbrella term for liver conditions caused by significant and chronic alcohol abuse. It initially causes liver [[steatosis]], which progresses to alcoholic hepatitis to [[cirrhosis]] unless alcohol consumption stops. | '''Alcoholic liver disease''' (ALD) is an umbrella term for liver conditions caused by significant and chronic [[alcohol]] abuse. It initially causes liver [[steatosis]], which progresses to alcoholic hepatitis to [[cirrhosis]] unless alcohol consumption stops. | ||
Almost all who abuse alcohol develop liver steatosis, which is reversible, but only a few progress to hepatitis and cirrhosis. Hepatitis C is often found in chronic alcoholics and leads to acceleration of alcoholic liver disease. | Almost all who abuse alcohol develop liver steatosis, which is reversible, but only a few progress to hepatitis and cirrhosis. [[Hepatitis C]] is often found in chronic alcoholics and leads to acceleration of alcoholic liver disease. | ||
Excessive ethanol consumption causes more than 60 % of chronic liver diseases in the Western countries and is the 5th leading cause of death. Alcoholic liver disease is a major cause of liver transplantation. | Excessive ethanol consumption causes more than 60% of chronic liver diseases in the Western countries and is the 5th leading cause of death. Alcoholic liver disease is a major cause of [[liver transplantation]]. | ||
== Etiology == | == Etiology == | ||
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** Non-specific symptoms like nausea, loss of appetite, weight loss | ** Non-specific symptoms like nausea, loss of appetite, weight loss | ||
** Tender hepatomegaly | ** Tender hepatomegaly | ||
** Jaundice | ** [[Jaundice]] | ||
* Alcoholic cirrhosis | * Alcoholic cirrhosis | ||
** General symptoms of cirrhosis | ** General symptoms of [[cirrhosis]] | ||
Some cases of alcoholic liver disease are detected incidentally in the cirrhosis stage. | Some cases of alcoholic liver disease are detected incidentally in the cirrhosis stage. | ||
It’s important to keep in mind that alcohol abuse is dangerous to all organ systems, and symptoms of e.g. cardiomyopathy, neuropathy, and encephalopathy may be present. | It’s important to keep in mind that alcohol abuse is dangerous to all organ systems, and symptoms of e.g. [[cardiomyopathy]], neuropathy, and encephalopathy may be present. | ||
== Diagnosis and evaluation == | == Diagnosis and evaluation == | ||
For diagnosis of alcoholic liver disease, it’s important to establish the diagnosis of alcohol abuse, in which case heteroanamnesis may be required. The following laboratory alterations are typical: | For diagnosis of alcoholic liver disease, it’s important to establish the diagnosis of alcohol abuse, in which case heteroanamnesis may be required. The following laboratory alterations are typical: | ||
* AST/ALT ratio > 2 (but both are elevated) | * [[AST/ALT ratio]] > 2 (but both are elevated) | ||
* Macrocytic anaemia | * [[Macrocytic anaemia and megaloblastic anaemia|Macrocytic anaemia]] | ||
* Elevated | * Elevated [[GGT]] | ||
Serum ethanol levels can be measured, but this only elevated in case of intake in the last hours. Phosphatidylethanol (PEth), a phospholipid which is only formed after alcohol consumption, is a marker of long-term alcohol intake. Carbohydrate-deficient transferrin (CDT) is another marker of long-term alcohol intake. | Serum ethanol levels can be measured, but this only elevated in case of intake in the last hours. [[Phosphatidylethanol]] (PEth), a phospholipid which is only formed after alcohol consumption, is a marker of long-term alcohol intake. Carbohydrate-deficient transferrin (CDT) is another marker of long-term alcohol intake. | ||
Ultrasound | [[Ultrasound]] shows characteristic findings depending on the stage. However, it cannot determine whether the cause of liver disease is alcoholic: | ||
* Steatosis – hepatomegaly, increased liver echogenicity | * Steatosis – hepatomegaly, increased liver echogenicity | ||
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* Cirrhosis – nodular liver surface, atrophy, loss of structural homogeneity | * Cirrhosis – nodular liver surface, atrophy, loss of structural homogeneity | ||
CT and MRI, as well as special techniques like FibroScan, transient elastography (TE) and acoustic radiation force impulse (ARFI) may also be used. | [[CT]] and [[MRI]], as well as special techniques like [[FibroScan]], [[transient elastography]] (TE) and [[acoustic radiation force impulse]] (ARFI) may also be used. | ||
It’s important to rule out other causes of liver disease, including viral and autoimmune. | It’s important to rule out other causes of liver disease, including viral and autoimmune. | ||
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Abstinence is essential to reverse early stages of alcoholic liver disease and to prevent progression in later stages. Abstinence is difficult, and both non-pharmacological and pharmacological interventions should be utilised to achieve it. | Abstinence is essential to reverse early stages of alcoholic liver disease and to prevent progression in later stages. Abstinence is difficult, and both non-pharmacological and pharmacological interventions should be utilised to achieve it. | ||
In case of hepatitis, | In case of hepatitis, [[corticosteroids]] may be helpful in severe cases to reduce mortality. | ||
Other treatments which may be useful: | Other treatments which may be useful: | ||
* Metadoxine – a drug which may increase alcohol elimination and may have a beneficial effect on ALD | * [[Metadoxine]] – a drug which may increase alcohol elimination and may have a beneficial effect on ALD | ||
* N-acetylcysteine | * [[N-acetylcysteine]] | ||
* Hepatoprotective antioxidants | * Hepatoprotective antioxidants | ||
Regular screening for cirrhosis, oesophageal varices, and hepatocellular carcinoma is indicated. If cirrhosis has developed, treatment aims at preventing complications like ascites, varices, and encephalopathy. | Regular screening for [[cirrhosis]], [[Oesophageal varice|oesophageal varices]], and [[hepatocellular carcinoma]] is indicated. If cirrhosis has developed, treatment aims at preventing complications like [[ascites]], varices, and encephalopathy. | ||
[[Category:Gastroenterology]] | [[Category:Gastroenterology]] | ||