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Alcoholic liver disease

Dr Anuradha Dassanayake

Alcohol and the liver


Fatty liver Alcoholic hepatitis Alcoholic cirrhosis Hepato cellular carcinoma Alcoholic can present for the first time with cirrhosis.

Safe limit of alcohol


14 units a week for females 7 units a week for males

Half a bottle of arrack week 2 bottles of Beer aweek

ALD

Almost 100% have fatty liver 10-35% have alcoholic hepatitis 10% progress to cirrhosis

ALD

ALD may develop at a lower dose in females and in patients with hepatitis C

ALD

ALD is more severe develops rapidly at a lower threshold in females

Malnutrition

Malnutrition may not play a part Obesity

Genetic factors

Genetics probably will explain why only about 1/3 of heavy drinkers develop the disease. Exact genetic defect not identified yet

Alcoholic hepatitis

Can be acute onset in otherwise healthy Hepatomegaly and Jaundice SGOT>SGPT not very high Gamma GT elevated

Alcoholic hepatitis

Can be very severe with high mortality By definition they are not candidates for transplantation

Alcoholic hepatitis

Abstinence and supportive care Nutrition/ Management of complications Steroids Pentoxifylline

in severe disease and diagnosis is confirmed PT above control in seconds x 4.6 + Bilirubin>32 Encephalopathy

ALD

Liver biopsy should be performed before steroids Sepsis should be excluded

Alcoholic cirrhosis

Commonest cause of cirrhosis and HCCour studies With Hep commonest cause of cirrhosis in the Western world Abstinence is key with proprer nutrition, proteins ,vitamins Prognosis can be very good compared to other liver diseases as you are taking out the aetiological factor.

ALD and iron over load


Iron overload can be severe in ALD May mimic haemochromatosis May damage other organs May be benefitted by venesection.

Transplantation

Transplantation is offered for people who abstain for 6 months.