Alcoholic liver disease

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Alcoholic liver disease
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Alcoholic liver disease

• Alcoholic steatosis
• Acute alcoholic hepatitis
• Alcoholic cirrhosis

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Diagnosis

• CAGE criteria
• Have you felt the need to Cut down drinking?
• Have you ever felt Annoyed by criticism of
  drinking?
• Have you had Guilty feelings about drinking?
• Do you ever take a morning Eye opener?

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Laboratory studies

• ASTgtALT
• ratio usually gt2.0, both usually lt300 IU/L, and
  almost never gt500 IU/L
• ?GGT
• ?MCV
• ?Carbohydrate-deficient transferrin (CDT)

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Risk factors

• Amount of ethanol ingested
• 80 grams of ethanol daily for 10 to 20 years
• Coexisting hepatitis viral infection
• Concurrent exposure to hepatotoxins
• Vitamin A, acetaminophen, iron

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Risk factors

• Genetic factors
• Female, Asians, C282Y mutation of the HFE gene
• Malnutrition
• Obesity and DM

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Index of prognosis

• Maddrey score
• Discriminant function (4.6 x prothrombin time
  - control PT) (serum bilirubin)
• Score gt 32 high short-term mortality (3545),
  indication of corticosteroids use
• Model for end stage liver disease score (MELD
  score)
• MELD 3.8Ln serum bilirubin (mg/dL) 11.2Ln
  INR 9.6Ln serum creatinine (mg/dL) 6.4
• Score 21 90-day mortality

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Treatment

• Acute alcoholic hepatitis
• Oral benzodiazepines for alcohol withdrawal
• Nutritional support (fluid, vitamin, calories,
  magnesium and phosphate)
• Subcutaneous vitamin K if PT prolongation
• Corticosteroids prednisolone, 40 mg daily for
  four weeks if discriminant function gt 32 or
  hepatic encephalopathy

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Treatment

• Long term therapy of alcoholic liver disease
• Propylthiouracil reduce hypoxia change of
  hepatocytes
• Metadoxine reduce steatosis
• Polyunsaturated lecithin, Colchicine, and
  S-adenosylmethionine?
• Liver transplantation.