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Tuesday, January 22, 2008

Alcoholic Liver Disease

Alcoholic Liver Disease
This is the most common cause of liver cirrhosis in most parts of the world. Alcohol related liver injury passes through three distinct clinical phases such as acute fatty liver, alcoholic hepatitis and alcoholic cirrhosis. In a given patient these may occur in varying combinations. Acute fatty change of alcohol abuse may progress to cirrhosis in 20% of patients. Alcoholic hepatitis develops only in a small proportion of patients after decades of abuse. This condition may progress to cirrhosis. Once cirrhosis develops it is irreversible and progress at the rate of 10% annum if there is no further insult. Liver cancer can develop in 20% of these cirrhotics.

Alcoholic fatty liver disease:
Fatty change occurs after consumption of large amounts of alcohol over a short period of time. The liver tests and clinical liver swelling returns to normal after abstaining from alcohol. The fat clearance fro the liver takes place in 2-6 weeks. With continued abuse of alcohol this may progress to hepatitis and cirrhosis. Fatty change may persist in some after abstaining from alcohol when they have obesity, diabetes or pancreatitis.

Alcoholic Hepatitis:
This is a state with a wide spectrum of presentation ranging from mild swelling of the liver to severe jaundice, fluid in the abdomen including hepatic coma। The symptoms include lethargy, anorexia, fatigue, vague abdominal pain and rarely jaundice. Women tend to have more florid illness. Approximately 50% may have fluid collection in the abdomen. Bleeding tendency may manifest as easy bruising of skin. Blood tests will reveal a rise in liver enzymes, bilurubin and alkaline phosphatase. Low haemoglobin and high white cell counts are common. In the more severely ill, platelet count will be low and the prothrombin time will be elevated and incompletely corrected with treatment.

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