Alcoholic Liver Disease | Aarohi Kadam

Etiopathogenesis Alcohol intake Alcohol is metabolised by the liver to acetaldehyde by mitochondrial enzyme,ADH. Acetaldehyde forms adducts with cellular proteins in hepatocytes which activate the immune system,leading to cell injury. Acetaldehyde then metabolism to acetyl coA and acetate by ALD,this generate NADH,which changes redox potential of cell Cytochrome CYP2E1 is induced by alcohol,which generates microsomal peroxidation leading to oxygen free radicals formation leading to mitochondrial damage PATHOLOGY= Alcoholic hepatitis Lipogranuloma Neutrophil infiltration Mallory hyaline Pericellular fibrosis Macrovesicular steatosis Fibrosis and cirrhosis Central hyaline sclerosis C/F Clinical syndrome of alcoholic liver disease 1. Fatty liver abnormal liver biochemistry ,normal/large liver 2. Alcoholic hepatitis Jaundice Malnutrition Hepatomegaly Portal hypertension features like ascites ,encephalopathy 3. Cirrhosis= Stigmata of chr liver disease Large/normal liver Ascites Encephalopathy Hepatocellular carcinoma INVESTIGATION Clinical history form pt abt alcohol misuse, durant ,severity Biological markers in absence of anaemia Raised GGT will be elevated in hepatic steatosis and fibrosis Unexplained rib fracture on chest x ray suggest alcohol misuse Presence jaundice suggest alcoholic hepatitis Liver biopsy Maddrey's score by prothrombin time and bilirubin give discriminant function MANAGEMENT Cessation of alcohol consumption. Life long abstinence is best advice Treatment of complication of cirrhosis such as variceal bleeding ,encephalopathy and ascites Nutrition is imp and enteral feeding via fine bore nasogastric tube needed. Corticosteroids r of valve in pt with severe alcoholic hepatitis Pentoxifylline,a weak anti TNFaction beneficial in severe alcoholic hepatitis Liver transplantation.