Alcoholic liver disease natural history, complications and prognosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: M. Khurram Afzal, MD [2]
Overview
Alcoholic liver disease progresses through three stages (steatosis, alcoholic hepatitis, and cirrhosis) with the continued use of alcohol. Serious complications begin to occur with the development of alcoholic hepatitis, when portal hypertension, coagulopathies, and intractable jaundice. Complications of cirrhosis include hepatic encephalopathy and hepatocellular carcinoma. Prognosis varies dependent on level of progression of illness, and whether treatment is given. Prognosis can be measured using laboratory values, and three prognostic scores: The MELD score, the Glasgow Alcoholic Hepatitis Score, and the ABIC score.
Natural History
Significant aspects regarding natural history of alcoholic liver disease include:[1][2][3]
- Alcoholic liver disease is thought to progress through three main histological stages with the continued use of alcohol.
- Steatosis is the first stage occuring when triglycerides accumulate in hepatocytes.
- This is reversible with abstinence.
- Steatohepatitis or alcoholic hepatitis is the next stage characterized by:
- Fatty change
- Inflammation
- Hepatocellular injury
- Necrosis
- The last stage is cirrhosis which is characterized by:
- Dense and diffuse micronodular fibrosis.
- This stage is irreversible, and is a risk factor for the development of hepatocellular carcinoma.
Complications
Alcoholic hepatitis
Complications of alcoholic hepatitis include:[2][3][4][5][6][7]
- Portal hypertension (ascites, variceal bleeding, hepatorenal syndrome)
- Coagulopathy
- Intractable jaundice
Cirrhosis
Complications of cirrhosis include:[2][3][4][5][6][7]
Prognosis
Poor Prognostic Factors
Poor prognostic factors of alcoholic liver disease include:[4][5][8]
- Prolonged prothrombin time
- Serum Bilirubin >10 mg/dL
- Hepatic encephalopathy
- Azotemia
- Leukocytosis
- Unresponsive to steroid treatment
- Reverse portal flow on doppler ultrasound
Prognostic Scores
Prognostic scores used to assess the prognosis of patients with alcoholic liver disease include:[4][5][8]
- MELD score for cirrhosis
- Glasgow alcoholic hepatitis score (age, white blood cell, blood urea nitrogen, prothrombin time ratio, and bilirubin level)
- ABIC score - age, serum bilirubin, serum creatinine
2010 AASLD/ACG Alcoholic Liver Disease Guidelines (DO NOT EDIT)[9]
Prognostic factors : Guidelines (DO NOT EDIT)[9]
| Class I |
| 1. " Patients presenting with a high clinical suspicion of alcoholic hepatitis should have their risk for poor outcome stratified using the Maddrey Discriminant Function (MDF), as well as other available clinical data. Evaluating a patient's condition over time with serial calculation of the Model for End-Stage Liver Disease (MELD) score is also justified. (Level of evidence: B) " |
References
- ↑ Ceni E, Mello T, Galli A (2014). "Pathogenesis of alcoholic liver disease: role of oxidative metabolism". World J. Gastroenterol. 20 (47): 17756–72. doi:10.3748/wjg.v20.i47.17756. PMC 4273126. PMID 25548474.
- ↑ 2.0 2.1 2.2 Mathurin P, Bataller R (2015). "Trends in the management and burden of alcoholic liver disease". J. Hepatol. 62 (1 Suppl): S38–46. doi:10.1016/j.jhep.2015.03.006. PMC 5013530. PMID 25920088.
- ↑ 3.0 3.1 3.2 Lucey MR, Mathurin P, Morgan TR (2009). "Alcoholic hepatitis". N. Engl. J. Med. 360 (26): 2758–69. doi:10.1056/NEJMra0805786. PMID 19553649.
- ↑ 4.0 4.1 4.2 4.3 Allampati S, Mullen KD (2016). "Long-Term Management of Alcoholic Liver Disease". Clin Liver Dis. 20 (3): 551–62. doi:10.1016/j.cld.2016.02.011. PMID 27373616.
- ↑ 5.0 5.1 5.2 5.3 O'Shea RS, Dasarathy S, McCullough AJ (2010). "Alcoholic liver disease". Hepatology. 51 (1): 307–28. doi:10.1002/hep.23258. PMID 20034030.
- ↑ 6.0 6.1 Adachi M, Brenner DA (2005). "Clinical syndromes of alcoholic liver disease". Dig Dis. 23 (3–4): 255–63. doi:10.1159/000090173. PMID 16508290.
- ↑ 7.0 7.1 Gaglio PJ, Gaglio PJ (2012). "Complications in patients with alcohol-associated liver disease who undergo liver transplantation". Clin Liver Dis. 16 (4): 865–75. doi:10.1016/j.cld.2012.08.013. PMID 23101987.
- ↑ 8.0 8.1 Torruellas C, French SW, Medici V (2014). "Diagnosis of alcoholic liver disease". World J. Gastroenterol. 20 (33): 11684–99. doi:10.3748/wjg.v20.i33.11684. PMC 4155359. PMID 25206273.
- ↑ 9.0 9.1 "www.aasld.org" (PDF). Retrieved 2012-10-27.