MS/00062/016.

Kimutai A. Koech.
Objectives.

• To understand ethanol metabolism.

• To understand the pathogenesis of alcoholic liver disease.
• To know the risk factors in alcoholic liver disease.
• To describe the morphology of the three injury forms of
alcoholic liver disease
• To know the major clinical features of alcoholic liver disease.
Alcohol metabolism.
Alcoholic liver disease.

• Is a term used to describe spectrum of liver injury associated

with acute and chronic alcoholism.

• These are:
a. Hepatic steatosis.
b. Alcoholic hepatitis.
c. Alcoholic cirrhosis.
Alcoholic liver disease.
 Pathogenesis.
• Habitual intake.
• Induction of aldehyde and MEOS pathways.
• Production of acetaldehyde-->Increased NADH:NAD ratio-->TG
accumulation.
• Impaired lipoprotein secretion by ethanol.
=Fatty change and cell death.
• Aldehyde metabolites(acetaldehyde protein adducts) and ROS
production(MEOS) directly toxic to the hepatocytes.
=Hepatitis.
• Cell death--> infalmmatory response--> cytokine production.
• Hepatic stellate cell activation hence production of collagen.
=Cirrhosis/fibrosis.
Risk factors.
1. Drinking patterns- chronic alcoholism.
2. Gender- F>M.
3. Malnutrition- attrbuted to chronic gastritis and pancreatitis.
4. Infections- Bacterial/Viral may accelerate the disease
process.
5. Genetic factors.
6. Hepatitis C infection.
1. Hepatic Steatosis(fatty liver.)

• Morphology:
• Gross; enlarged(>2kg), yellow, greasy, firm, smooth liver with a
glistening capsule.
• Micro;
üSwollen hepatocytes.
üMicrovesicular and macrovesicular hepatocytes with nucleus
displaced to the periphery.
üFat cysts
Hepatic steatosis.
Hepatosteatosis.
2. Steatohepatitis(Alcoholic hepatitis.)
• Morphology:
üHepatocyte ballooning.
üHepatocyte degeneration and necrosis.
üMallory-Denk bodies.
*Not specific for alcoholic liver disease.
üAcute inflammatory infiltrate in the lobule(neutrophil
infiltration).
Alcoholic hepatitis.
Necrotic hepatocyte.
3. Alcoholic cirrhosis(fibrosis).

• Morphology:
• Gross;
üLarge, yellow-tan, fatty liver(>2kg) and micronodular
cirrhosis(<3mm) which over years becomes shrunken, brown,
non-fatty with macronodular fibrosis(>3mm).
• Micro;
üPerivenular fibrosis: -central v. sclerosis
-chickenwire fence pattern.
üFibrous septa around hepatocellular nodules.
Alcoholic fibrosis.
Alcoholic fibrosis.
Clinical features.

• Malaise, fever, anorexia, weight loss, R.U.Q pain, jaundice,

tender hepatomegaly.
• Alcoholic cirrhosis manifestations:
üAscites.
üCaput medusa.
üVariceal hemorrhage.
üHepatic encephalopathy.
üPalmar erythema.
Dx.
Ø History+clinical features+lab findings.

• Lab findings:
ü Elevated transaminases. AST>ALT
ü Rise in serum GGT
ü Increased serum ALP
ü Uric acid levels are elevated
ü Hyperbilirubinemia
ü MCV increased.
ü Neutrophilic leukocytosis
 Causes of death.
• Hepatic failure.
• Hepatorenal syndrome.
• Hepatocellular Carcinoma.
• Intercurrent Infection.
• Massive GI haemorrhage.
https://www.webpathology.com/image.asp?case=715&n=20
References.
• Robbins Basic Pathology, 10th Edition.
• Rubin’s Pathology Clinicopathologic Foundations of
Medicine, 7th Edition.
 THE END.

The prophet Isaiah warned, “Woe to him that is mighty to

drink wine.”