Alcoholic liver disease
| Alcoholic liver disease | |
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| Microscopy of liver showing fatty change, cell necrosis, Mallory bodies | |
| ICD-10 | K70 |
| ICD-9 | 571.1 |
| MedlinePlus | 000281 |
| MeSH | D008108 |
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Alcoholic liver disease Microchapters |
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Diagnosis |
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Treatment |
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Case Studies |
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Alcoholic liver disease On the Web |
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American Roentgen Ray Society Images of Alcoholic liver disease |
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Risk calculators and risk factors for Alcoholic liver disease |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Priyamvada Singh, M.B.B.S. [2], Prashanth Saddala M.B.B.S
Overview
Historical Perspective
Pathophysiology
Causes
Differentiating Alcoholic liver disease from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
History and Symptoms | Physical Examination | Laboratory Findings | Electrocardiogram | X Ray | CT | MRI | Echocardiography or Ultrasound | Other Imaging Findings | Other Diagnostic Studies
Treatment
Medical Therapy | Primary Prevention | Secondary Prevention | Cost-Effectiveness of Therapy | Future or Investigational Therapies
Case Studies
Ultrasonography
- Used for excluding biliary obstruction
- Ascites
CT scan
- To exclude pancreatic disease
- To exclude Space occupying lesions
- Collateral vessels
MRI
- To exclude pancreatic disease
- To exclude space occupying lesions
- Collateral vessels
Liver biopsy
- Fatty liver
- Macrovesicular fat
- Alcoholic hepatitis
- Polymorphonuclear infiltration
- Hepatic necrosis
- Mallory bodies in hepatocytes
- Perivenular and perisinusoidal fibrosis
- Ballooning hepatocytes
- Steatosis,
- Alcoholic cirrhosis
Treatment
Medical therapy
General
- Abstinence from alcohol
- Counseling and family support during alcohol abstinence
- Naltrexone or acamprosate to reduce relapse
- Nutritional support - Adequate amounts of carbohydrates and calories as alcoholics are commonly malnourished. This prevents endogenous protein catabolism, and hypoglycemia. Administration of thiamine is important with glucose supplements. This is so because glucose administration increases B1 consumption and B1 deficiency may lead to Wernicke–Korsakoff syndrome.
- Folic acid, thiamine, and zinc supplements are recommended.
Drug therapy
Alcoholic hepatitis
- Methylprednisolone
- Decreases short term mortality
- Usually given for 1 month
- Serum bilirubin is used as a predictor for treatment success. Failure of the serum bilirubin level to decline after 7 days of treatment predicts poor prognosis
- Another predictor of treatment is Lille model comprising, age, serum creatinine, serum albumin, prothrombin time (or INR), serum bilirubin on admission, and serum bilirubin on day 7
- Pentoxifylline
- It is a tumor necrosis factor inhibitor
- Used in patients with contraindications to steroids
- Usually given for 1 months
- Decreases mortality
- Decreases risk of hepatorenal syndrome
Other less commonly used drugs