Alcoholic Liver Disease – B. Pharma 2nd Semester Pathophysiology notes pdf

Alcoholic Liver Disease

Alcoholic Liver Disease

Objectives

At the end of this session, student will be able to –

       Explain the Pathogenesis of Alcoholic Liver Disease

       Describe the Symptoms of Alcoholic Liver Disease

       Explain various laboratory diagnosis test for Alcoholic liver Disease

Alcoholic Liver Disease

Alcoholic liver disease is the term used to describe the spectrum of liver injury associated with acute and chronic alcoholism

Signs and Symptoms

       Progresses in the liver as inflammation (hepatitis) and leads to fatty liver and cirrhosis

Early Symptoms

  1. Fatigue: Feeling excessively tired is one of the initial signs of ALD.
  2. Abdominal Discomfort: A vague, persistent pain or discomfort in the abdominal area.
  3. Loss of Appetite: Reduced interest in food and subsequent weight loss.
  4. Nausea and Vomiting: Frequent feelings of nausea and occasional vomiting.
  5. Jaundice: A yellowing of the skin and whites of the eyes.

Advanced Symptoms

  1. Ascites: Accumulation of fluid in the abdominal cavity.
  2. Portal Hypertension: High blood pressure in the portal vein.
  3. Confusion and Impaired Cognitive Function: Due to the liver’s inability to filter toxins.
  4. Easy Bruising and Bleeding: A decline in platelet production.
  5. Swelling in the Legs and Ankles: Known as edema.

Risk factors

       Occurs after many years of excessive drinking

       Acute alcoholic hepatitis – Binge drinking

       Severe drinking – Life threatening

       Genetic factors – Women have increased susceptibility to develop advanced alcoholic liver disease with much lesser alcohol intake

       Malnutrition

       Toxicity of ethanol in liver

       Infection – Hepatitis C infection

Distinctive forms of Alcoholic Liver Disease

Hepatic Steatosis (Fatty liver)

        Moderate consumption – Deposition of small lipid droplets in hepatocytes

         Excessive consumption – accumulation of lipids in macrovascular  droplets

         Nucleus gets displaced, Enlarged liver

Alcoholic hepatitis

        Necrosis of liver cells in centrilobular region

        Neutrophillic reaction

         Fibrosis

Alcoholic Cirrhosis

        Irreversible – Final stage

        Liver turns brown, shrunken and non-fatty appearance

        Resembles post necrotic cirrhosis 

Pathogenesis of Alcoholic Liver Disease

Ethanol Metabolism

Pathogenesis of Alcoholic Liver Disease
Ethanol Metabolism

ADH = Alcohol Dehydrogenase; ALDH or ACDH = Hepatic Acetaldehyde Dehydrogenase; NAD = Nicotinamide Adenine Dinucleotide; NADH = Reduced NAD

       Direct hepatotoxicity by ethanol to microtubules, mitochondria, membrane hepatocytes

       Hepatotoxicity by ethanol metabolites

      Production of protein-aldehyde adducts

      Formation of malo-di-aldehyde-acetaldehyde (MAA)

       Oxidative Stress –  oxidation of ethanol by cytochrome 450 oxidase, generation of free radicals and oxidative damage

       Immunological attacks on hepatocytes

       Fibrogenesis

      Damaged hepatocytes,

      Malon-di-aldehyde-acetaldehyde adducts,

      Activated kupffer cells, and

      Direct stimulation by acetaldehyde

Pathogenesis of Alcoholic Liver Disease
Ethanol Metabolism

Laboratory Diagnosis For Alcoholic Liver Disease

Diagnosing ALD involves a combination of clinical evaluation, laboratory tests, and imaging techniques.

Blood Tests

  1. Liver Function Tests: Assess liver enzymes and bilirubin levels.
  2. Complete Blood Count: Detect changes in blood cells.
  3. Carbohydrate-Deficient Transferrin (CDT): A specific marker of heavy alcohol use.

Imaging Techniques

  1. Ultrasound: Used to evaluate liver size and detect abnormalities.
  2. CT Scan: Provides detailed images of the liver’s structure.
  3. FibroScan: Measures liver stiffness, a sign of fibrosis.

       Elevated transaminases: increase in SGOT (AST) is more than that of SGPT (ALT)

       Rise in serum γ-glutamyl transpeptidase (γ-GT)

       Elevation in Serum alkaline phosphatase

       Hyperbilirubinaemia

       Hypoproteinaemia with reversal of albumin-globulin ratio

       Prolonged prothrombin time and partial thromboplastin time

       Anemia and Neutrophilic leucocytosis

Preventive Measures

Preventing ALD begins with responsible alcohol consumption.

Reducing Alcohol Consumption

  1. Limit alcohol intake to recommended guidelines.
  2. Seek professional help if struggling with alcohol dependence.

Maintaining a Healthy Lifestyle

  1. Eat a balanced diet.
  2. Exercise regularly.
  3. Ensure regular check-ups with your healthcare provider.

Treatment Options

When diagnosed with ALD, it’s crucial to take appropriate steps.

Lifestyle Changes

  1. Alcohol Abstinence: The most effective treatment.
  2. Nutritional Support: Ensure proper nutrient intake.

Medications

  1. Corticosteroids: May be prescribed for severe cases.
  2. Ursodeoxycholic Acid (UDCA): Used to manage cholestasis.

Conclusion

Alcoholic Liver Disease is a serious condition that can have devastating consequences. Understanding its symptoms, pathogenesis, and diagnostic methods is essential for early detection and effective management. Responsible alcohol consumption and a healthy lifestyle are key to prevention. In case of diagnosis, prompt intervention is crucial for a better prognosis.

FAQs on Alcoholic Liver Disease

1. Can occasional alcohol consumption lead to ALD?

Occasional alcohol consumption is less likely to lead to ALD. However, it’s essential to be mindful of your alcohol intake, as the risk accumulates over time.

2. Is ALD reversible?

In the early stages, ALD is reversible by abstaining from alcohol and making lifestyle changes. Advanced stages may have irreversible damage.

3. Are there any specific diets for ALD patients?

A well-balanced diet is recommended for ALD patients, with a focus on limiting sodium and ensuring adequate protein intake.

4. How is ALD different from non-alcoholic fatty liver disease (NAFLD)?

ALD is caused by excessive alcohol consumption, while NAFLD is linked to obesity and metabolic factors. They have different underlying causes.

5. What are the long-term complications of ALD if left untreated?

If left untreated, ALD can progress to cirrhosis, liver failure, and an increased risk of liver cancer, which can be life-threatening.

Summary

       Alcohol liver disease is damage to liver and its function due to alcohol abuse

       Progresses in the liver as inflammation (hepatitis) and leads to fatty liver and cirrhosis

       Major forms include hepatic steatosis, hepatitis, cirrhosis

       Alcohol is a caloric food source which displaces nutrients

       Causes the activation of Kupffer cells and release of proinflammatory mediators

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