Spectrum of Liver Disease

Spectrum of Liver Disease

The thee most widely recognized forms of ALD are alcoholic fatty liver ( steatosis), acute alcoholic Hepatitis, and alcoholic cirrhosis. Although 90-100 per cent of heavy drinkers show evidence of fatty liver, only 10-35 per cent develop alcoholic Hepatitis and 8-20 per cent develop cirrhosis. 

Alcoholic fatty liver : Alcoholic fatty liver appears if consumption exceeds 80 gm. of alcohol per day. Liver function is often normal and alcoholic fatty liver is reversible with abstinence. 

Acute alcoholic Hepatitis : It is estimated that 15-20 years of excessive drinking is necessary to develop alcoholic Hepatitis. High mortality rates are seen ( 30-60 per cent) and patients often deteriorate despite abstinence. Alcoholic Hepatitis is an important precursor to the formation of cirrhosis. 

Cirrhosis : This is the most severe form of alcoholic liver injury. The risk is increased in continuous drinkers. Survival for patients is 60-70 per cent at one year and 35-50 per cent at five years. 

Symptoms and Signs 

The symptoms of ALD are usually non-specific, and do not necessarily indicate the severity of the underlying liver damage. Many patients with advanced ALD have no symptoms and are detected due to abnormal results of the blood tests performed as part of routine health screening, or during investigations of other conditions. Many people will have vague symptoms such as fatigue, nausea and vomiting ( typically in the morning), diarrhoea or abdominal pain. Only in the more advanced stages of ALD will the sufferer present with more specific liver-related symptoms such as jaundice, ascites ( fluid collecting in the abdomen, causing distensioin), haematemesis (vomiting of blood) or encephalopathy ( confusion, reduced level of awareness and altered sleep pattern, eventually progressing to coma ). These are signs of severe liver damage and require urgent medical treatment. 

Diagnosis

Common laboratory findings in alcoholic Hepatitis : 

1. Increase in white blood cells.

2. AST 2-3 times higher than ALT ( ALT usually < 100 IU/L).

3. Increased serum bilirubin level; correlates with severity. 

4. Prolonged prothrombin time; correlates with severity. 

5. Decreased serum albumin level. 

6. Decreased serum cholesterol level. 

7. Decreased serum triiodothyronine level ( T3- a thyroid hormone).

Alcoholic Liver Disease
Spectrum of Liver Disease
Treatment for Alcoholic Liver Disease