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Alcoholic Liver Disease (Treatment (Alcoholic hepatitis (Steroids show…
Alcoholic Liver Disease
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Pathophysiology
Alcoholic hepatitis
Dense cytoplasmic inclusions called Mallory bodies are sometimes seen in hepatocytes and giant mitochondria are also a feature
If alcohol consumption continues, alcoholic hepatitis can progress to cirrhosis
In addition to fatty change there is infiltration by polymorphonuclear leucocytes and hepatocyte necrosis
Alcoholic cirrhosis
Classically of the MICRONODULAR TYPE but mixed pattern is also seen accompanying fatty change, and evidence of pre-existing alcoholic hepatitis may be present
Fatty liver
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This is the minimal with small amounts of alcohol, but with larger amounts the cells become swollen with fat (steatosis)
In some cases, collagen is laid down around the central hepatic veins and this can sometimes progress to cirrhosis without a preceding hepatitis
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Alcohol directly affects stellate cells, transforming them into collagen-producing myo-fibroblast cells
Clinical Presentation
Alcoholic hepatitis
Mild to moderate symptoms of ill-health, occasionally with mild jaundice, may occur, signs of chronic liver disease. Liver biochemistry is deranged and the diagnosis is made on liver histology
In the severe cases the patient is ill, with jaundice and ascites. Abdominal pain is frequently present and a high fever is associated with liver necrosis
Patients may be well, with few symptoms, the hepatitis only being apparent on the liver biopsy in addition to fatty change
Alcoholic cirrhosis
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On examination there are usually signs of chronic liver disease - ascites, bruising, clubbing and Dupuytren's contracture
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Fatty liver
Vague abdominal symptoms of nausea, vomiting, diarrhoea are due to the more general effects of alcohol on the GI tract
Hepatomegaly, sometimes huge, can occur together with other features of chronic liver disease
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Treatment
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IV Thiamine to prevent Wernicke-Korsakoff encephalopathy (presents with ataxia, confusion and nystagmus) which occurs from alcohol withdrawal, occurs 6-34 hours after last drink and lasts up to a week
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