Heavy ethanol consumption produces a wide spectrum of hepatic lesions, the most characteristic being fatty liver (i.e., steatosis), hepatitis, and fibrosis/cirrhosis (see figure 2). Steatosis is the earliest, most common response that develops in more than 90 percent of problem drinkers who consume 4 to 5 standard drinks per day over decades (Ishak et al. 1991; Lieber 2004). (A standard drink is defined as the amount of alcoholic beverage that contains approximately 0.5 fluid ounces, or about 14 grams, of pure alcohol [figure 3]). However, steatosis also develops after binge drinking, defined as the consumption of 4 to 5 drinks in 2 hours or less. Steatosis was formerly considered a benign consequence of alcohol abuse. If the affected individual ceases drinking, steatosis is a reversible condition with a good prognosis.
Thrombocytopenia can result from the direct toxic effects of alcohol on bone marrow or from splenomegaly, which accompanies portal hypertension Portal Hypertension Portal hypertension is elevated pressure in the portal vein. It is caused most often by cirrhosis (in North America), schistosomiasis (in endemic areas), or hepatic vascular abnormalities. Neutrophilic leukocytosis may result from alcoholic hepatitis, although coexisting infection (particularly pneumonia and spontaneous bacterial peritonitis) should also be suspected.
Alcohol Related Liver Disease
However, studies involving patients with liver disease from many distinct causes have shown convincingly that fibrosis and cirrhosis might have a component of reversibility. For patients with decompensated alcoholic cirrhosis who undergo transplantation, survival is comparable to that of patients with other causes of liver disease with a 5-year survival of approximately 70%. Schematic depiction of the role of Kupffer cells (KCs) and alcoholic liver disease hepatic stellate cells (HSCs) in promoting alcohol-induced inflammatory changes and progression to fibrosis and cirrhosis. These factors attract immune cells (e.g., natural killer [NK] cells and natural killer T cells [NKT cells]) to the liver to exacerbate the inflammatory process. Activated HSCs secrete abundant extracellular matrix proteins (e.g., collagen type 1), forming scar tissue (fibrosis) that can progress to cirrhosis.
The altered ratio of NAD/NADH promotes fatty liver through the inhibition of gluconeogenesis and fatty acid oxidation. CYP 2E1, which is upregulated in chronic alcohol use, generates free radicals through the oxidation of nicotinamide adenine dinucleotide phosphate (NADPH) to NADP. Chronic alcohol exposure also activates hepatic macrophages, which then produce tumor necrosis factor-alpha (TNF-alpha). TNF-alpha induces mitochondria to increase the production of reactive oxygen species.
Spontaneous bacterial peritonitis may develop in patients with alcoholic hepatitis and ascites, especially in those with concomitant gastrointestinal bleeding. Following a confirmatory diagnostic paracentesis, broad-spectrum antibiotic therapy with a second- or third-generation cephalosporin is the treatment of choice. Oxidation of ethanol requires conversion of nicotinamide adenine dinucleotide (NAD) to the reduced form NADH. Because NAD is required for the oxidation of fat, its depletion inhibits fatty acid oxidation, thus causing accumulation of fat within the hepatocytes (steatosis).
What is an indicator of alcoholic liver disease?
Patients with alcoholic hepatitis will have scleral icterus and jaundice as well as tender hepatomegaly with or without ascites and if their hepatitis is severe will have asterixis and exhibit mental confusion on examination.
Some of the excess NADH may be reoxidized in the conversion of pyruvate to lactate. Accumulation of fat in the hepatocytes may occur within days of alcohol ingestion; with abstinence from alcohol, the normal redox state is restored, the lipid is mobilized, and steatosis resolves. The genetic factor that most clearly affects susceptibility is male or female sex. For a given level of ethanol intake, women are more susceptible than men to developing alcoholic liver disease (see Epidemiology). In most patients with alcoholic hepatitis, the illness is mild. The short-term prognosis is good, and no specific treatment is required.
When to Contact a Medical Professional
Refer patients to a program of rehabilitation and support, and strongly encourage them to attend. Also, fully inform patients regarding the serious potential health consequences of continued ethanol use. Most complications of alcoholic hepatitis are identical to those of cirrhosis.
- Once damage begins, it can take a long time to become noticeable, as the liver is generally highly effective at regenerating and repairing itself.
- A diet high in unsaturated fat increases susceptibility, as does obesity.
- Deficiencies in micronutrients (e.g., folate, vitamin B6, vitamin A, and thiamine) and minerals (e.g., selenium, zinc, copper, and magnesium) often occur in ALD and, in some instances, are thought to be involved in its pathogenesis (Halsted 2004).
- On further progression, there is marked steatosis, hepatocellular necrosis, and acute inflammation.
- In response to the endotoxins (which the impaired liver can no longer detoxify), liver macrophages (Kupffer cells) release free radicals, increasing oxidative damage.
If you drink more than it can process, it can become badly damaged. A CT scan of the upper abdomen showing a fatty liver (steatosis of the liver). Note the liver enlargement and dark color compared with the spleen (gray body in lower right). “We try to address the abuse disorder and the liver disease at the same time,” said Sengupta, a medical director of the Multidisciplinary Alcohol Program at the Digestive Disease & Surgery Institute at the Cleveland Clinic. There are many potential causes, from economic uncertainty to isolation during the pandemic to underlying trauma, researchers say.
The following organizations are good additional resources about alcohol-related liver disease…
Not all heavy drinkers develop alcoholic hepatitis, and the disease can occur in people who drink only moderately. There are normally no symptoms, and alcoholic fatty liver disease is often reversible if the individual abstains from alcohol from this point onward. This article explores the early signs and symptoms of alcoholic liver disease, its stages, causes, risk factors, treatments, and prevention. As emphasized in the most recent national practice guidelines, health care providers must be attentive for signs of covert alcohol abuse.18 Many patients do not openly disclose an accurate history of alcohol use. In addition, no physical examination finding or laboratory abnormality is specific for ALD.
The World Health Organization’s (2014)
Global Status Report on Alcohol and Health estimates that 50 percent of all deaths caused by cirrhosis were attributable to alcohol abuse. Patients with alcoholic hepatitis are prone to infections, especially when on steroids; this is particularly important as it might lead to a poor prognosis, acute renal injury, and multi-organ dysfunction. Patients with alcoholic hepatitis are at risk of alcohol withdrawal. Lorazepam and oxazepam are the preferred benzodiazepines for prophylaxis and treatment of alcohol withdrawal. Documentation of daily caloric intake is necessary for patients with alcoholic hepatitis, and nutritional supplementation (preferably by mouth or nasogastric tube) is an option if oral intake is less than 1200 kcal in a day. Hepatic injury in alcoholic hepatitis is most prominent in the perivenular area (zone 3) of the hepatic lobule.
Mechanisms Involved in Alcoholic Steatosis
Another reason could be that drinks have become more potent and people are “drinking more per unit volume,” Dr. Elliot Tapper, a liver disease expert and gastroenterology specialist at the University of Michigan Medical School in Ann Arbor, told NBC News. Cirrhosis or severe liver disease used to be something that mostly struck people in middle https://ecosoberhouse.com/article/what-is-the-life-expectancy-of-an-alcoholic/ age, or older. Increasingly, alcohol-related liver disease is killing younger people in the U.S. He was vomiting profusely and coughing up blood, early symptoms of liver damage. His doctor ran blood tests, and the results were frightening. Scientists of the Cirrhosis Research Program are working to find new ways to treat cirrhosis.
Symptoms include agitation, changing mood, confusion, and pain, numbness, or a tingling sensation in your arms or legs. The most important part of treatment is to stop drinking alcohol completely. If you don’t have liver cirrhosis yet, your liver can actually heal itself, that is, if you stop drinking alcohol.
Alcoholic liver disease
In addition, acetaldehyde reacts with glutathione and depletes this key element of the hepatocytic defense against free radicals. Other antioxidant defenses, including selenium, zinc, and vitamin E, are often reduced in individuals with alcoholism. Peroxidation of membrane lipids accompanies alcoholic liver injury and may be involved in cell death and inflammation. Ethanol and its metabolite, acetaldehyde, have been shown to damage liver cell membranes.
Most patients with moderate disease are undernourished and present with fatigue, fever, jaundice, right upper quadrant pain, tender hepatomegaly, and sometimes a hepatic bruit. Other manifestations of cirrhosis Cirrhosis Cirrhosis is a late stage of hepatic fibrosis that has resulted in widespread distortion of normal hepatic architecture. Long-term alcohol abuse can lead to dangerous damage called alcoholic liver disease. Alcoholic liver disease usually occurs after years of drinking too much.