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Alcoholic Liver Disease

Chronic and excessive alcohol consumption can cause alcoholic liver disease. For men, risk increases at over 60-80 grams of alcohol per day for 10 years, and for women over 20-40 grams per day for 10 years. Continuous heavy drinking poses more risk than intermittent drinking. Genetics also plays a role, as alcoholism is more common in identical twins. The three main types of alcoholic liver disease are alcoholic hepatitis, alcoholic steatohepatitis, and alcoholic cirrhosis, which can progress from fatty liver to inflammation and scarring of the liver.

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Nishanth Reddy
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394 views

Alcoholic Liver Disease

Chronic and excessive alcohol consumption can cause alcoholic liver disease. For men, risk increases at over 60-80 grams of alcohol per day for 10 years, and for women over 20-40 grams per day for 10 years. Continuous heavy drinking poses more risk than intermittent drinking. Genetics also plays a role, as alcoholism is more common in identical twins. The three main types of alcoholic liver disease are alcoholic hepatitis, alcoholic steatohepatitis, and alcoholic cirrhosis, which can progress from fatty liver to inflammation and scarring of the liver.

Uploaded by

Nishanth Reddy
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as PPTX, PDF, TXT or read online on Scribd
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ALCOHOLIC LIVER DISEASE

Introduction
• Alcohol is the most common cause of chronic liver disease worldwide
with consumption continuing to increase in many countries.
• Chronic and excessive alcohol can cause liver disease
Threshold for developing alcoholic liver disease
• intake >60-80g/day for 10 years in men
• Intake>20-40g/day for 10 years in women
Risk factors
Drinking pattern
• Liver damage is more likely to occur in continuous rather than
intermittent drinkers as this pattern gives the liver a chance to recover.
• Recommended- At least 2 alcohol-free days each week
Gender
• More in women, they have higher ethanol levels than men after
consuming the same amount of alcohol
• Probably due to reduced volume of distribution
Genetics
• Alcoholism is more concordant in monozygotic than dizygotic twins
• PNPLA3 gene (adiponutrin) has been implicated in pathogenesis of
ALD.
Nutrition
• Obesity increases the incidence of liver related mortality by over
fivefold in heavy drinkers
• Ethanol itself produces 7kcal/g and many other alcoholic drinks also
contain sugar which increases the calorific value and contribute to
weight gain.
Pathophysiology
Pathological features of ALD
• Lipogranulomas
• Neutrophil infiltration
• Mallory's hyaline
• Pericellular fibrosis
• Macro vesicular steatosis
• Fibrosis and steatosis
• Central hyaline sclerosis
Clinical features
3 types of ALD are recognised but these overlap considerably:
ALCOHOLIC HEPATITIS
• Asymptomatic
• Hepatomegaly
• Ocassionally,discomfort in right upper quadrant with tender
hepatomegaly, nausea, jaundice
• Elevated bilirubin, triglycerides and cholesterol
• Progression to cirrhosis is uncommon
• Ultrasound –fatty liver
• Biopsy-accumulation of fat in perivenular hepatocytes
• Cessation of alcohol results in normalisation of pathological changes
ALCOHOLIC STEATOHEPATITIS
• Fever, rapid onset of jaundice, abdominal discomfort, proximal muscle
wasting.
• Hepatomegaly
• Signs of chronic liver disease-spider angioma,palmar erythema, chapped
lips and gynaecomastia
• Portal hypertension,ascites,variceal bleeds in severe cases.
• AST and ALT- seven fold rise <400 IU
• Bilirubin-elevated
• Alkaline phosphatase-elevated
• Albumin-decreased
• prothrombin time-prolonged
• Leucocytosis elevated c reactive protein.
ALCOHOLIC CIRRHOSIS
• Micro nodular cirrhosis(Laennec’s cirrhosis)
• Involvement of every lobule of whole liver
• Regenerating nodules of less than 3mm in diameter
• Large, normal or small liver
• Ascitis,variceal haemorrhages, encephalopathy.
• Gynaecomastia, spider naevi,parotid enlargement.
• Dupuytren’s contracture, palmar erythema, spider naevi.
• Testicular atrophy,impotence.
• Half of such patients will survive 5 years from presentation
THANK YOU!

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