alcoholic liver disease (ALD)
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Epidemiology
- most alcoholics do NOT develop significant liver disease
Pathology
- alcohol induces hepatic microsomal enzymes
- enhanced risk of acetaminophen-induced hepatitis
- risk factor for progression to cirrhosis:
- excessive daily alcohol consumption
- long duration of alcoholism
- beverage type
- female sex
- concurrent HIV infection
- > 160 g of ethanol/day (> 14 oz of 80 proof whiskey/day) for > 10 years places patient at greatest risk for end- stage liver disease
Clinical manifestations
Laboratory
- complete blood count (CBC)
- prothrombin time/INR may be prolonged
- liver function tests may be abnormal
- decreased serum albumin
- increased serum ALT, serum AST with AST/ALT often > 2
- increased serum bilirubin, serum GGT, serum ALP
- serum cholesterol may be diminished
- screening for hepatocellular carcinoma with serum alpha-fetoprotein is not recommended because of poor sensitivity & specificity (may be used in conjunction with abdominal ultrasound for screening)
Diagnostic procedures
- upper GI endoscopy to screen for esophageal varices[4]
- repeat screening upper GI endoscopy in 2-3 years if no varices[4]
Radiology
- abdominal ultrasound (evaluation of cirrhosis & screening for hepatocellular carcinoma)[2][4]
- transient elastography to assess hepatic fibrosis[5]
Complications
- increased risk of upper GI bleeding
Management
- stop drinking
- specific treatment for specific complications
- adequate nutrition (2000 kcal/day)
- refer patients with advanced alcoholic liver diseased foor management & consideration of liver transplantation regardless of duration of abstinence from alcohol[1]
- liver transplantation
- abstinence from alcohol for > 6 monthy to 1 year
- good social support
- baclofen effective in preventing alcohol relapse in patients with alcoholic liver disease[2]
- nonselective beta-blocker or endoscopic variceal ligation for esophageal varices
More general terms
More specific terms
Additional terms
References
- ↑ 1.0 1.1 Medical Knowledge Self Assessment Program (MKSAP) 11, 16, 19. American College of Physicians, Philadelphia 1998, 2012, 2021.
- ↑ 2.0 2.1 2.2 Singal AK, Bataller R, Ahn J, Kamath PS, Shah VH. ACG clinical guideline: Alcoholic liver disease. Am J Gastroenterol 2018 Jan 16 PMID: https://www.ncbi.nlm.nih.gov/pubmed/29336434
- ↑ European Association for the Study of the Liver EASL Clinical Practice Guidelines: Management of alcohol- related liver disease. J Hepatol. 2018 Apr 5. pii: S0168-8278(18)30214-9 PMID: https://www.ncbi.nlm.nih.gov/pubmed/29628280 https://www.journal-of-hepatology.eu/article/S0168-8278(18)30214-9/fulltext
- ↑ 4.0 4.1 4.2 4.3 NEJM Knowledge+ Question of the Week. July 23, 2019 https://knowledgeplus.nejm.org/question-of-week/394/
Garcia-Tsao G, Abraldes JG, Berzigotti A, Bosch J. Portal hypertensive bleeding in cirrhosis: risk stratification, diagnosis, and management: 2016 practice guidance by the American Association for the Study of Liver Diseases. Hepatology 2017 Jan; 65:310. PMID: https://www.ncbi.nlm.nih.gov/pubmed/27786365 - ↑ 5.0 5.1 NEJM Knowledge+ Gastroenterology
- ↑ Crabb DW, Im GY, Szabo G, et al. Diagnosis and treatment of alcohol-associated liver diseases: 2019 practice guidance from the American Association for the Study of Liver Diseases. Hepatology. 2020;71:306-333. PMID: https://www.ncbi.nlm.nih.gov/pubmed/31314133