Alcoholic liver disease

Liver injury may develop in some people who consume alcohol. The pathogenesis of liver damage in such subjects remains obscure. Major histopathologic features of alcohol-associated liver injury include steatosis, steatonecrosis, and cirrhosis. The clinical manifestations of alcoholic liver disease are nonspecific and range from asymptomatic hepatomegaly to stigmata of portal hypertension with advanced parenchymal failure. The severity of the clinical presentation and the degree of aminotransferase elevation correlate poorly with the liver histopathology, particularly in patients who continue to drink alcohol. Short-term mortality of such patients is best predicted by a composite of clinical and laboratory parameters that are influenced by alcohol consumption as well as by liver disease. Long-term prognosis is determined by residual damage to vital organs (that is, whether or not cirrhosis has developed) and whether or not the patient continues to drink. Current therapy of alcoholic liver disease includes abstinence and correction of nutritional deficiencies. Other therapies are experimental and are best utilized in the setting of controlled clinical trials.     

Alcoholic liver disease

Alcoholic liver disease presents a wide spectrum of clinical manifestations ranging from mild asymptomatic fatty liver to alcoholic hepatitis and severe life-threatening liver failure with ascites, hemorrhaging esophageal varices, and encephalopathy. Although still poorly understood, the mechanism of this injury is probably the result of numerous direct toxic and metabolic effects of alcohol on the hepatocyte. Therapy consists primarily of abstinence and supportive care. However, several newer treatments are actively being studied. These include prednisolone, anabolic steroids, glucagon and insulin, propylthiouracil, and cyanidanol. Colchicine is promising as an agent to inhibit fibrosis. Complications of cirrhosis, including ascites and variceal hemorrhage, are the result of end stage disease. A return to old techniques of ascitic fluid management suggests that therapeutic large-volume paracentesis with albumin infusion is a safe and effective form of therapy. Variceal hemorrhage is best treated with sclerotherapy, vasoconstrictors, and balloon tamponade. Little has been done to alter the ultimately dismal prognosis and long-term survival of alcoholic liver disease.     

Alcoholic liver disease

Aggressive management to prevent alcoholic cirrhosis should include the use of biopsy results to diagnose and to monitor alcoholic liver disease. Guidelines for the interpretation of the liver biopsy are highlighted. The diagnosis, course, and treatment of alcoholic hepatitis and cirrhosis are presented in detail.     

Alcoholic heart disease

Alcoholic heart disease is caused by a lifestyle in which alcoholics are continue to consume an excessive amount of alcohol over a long period of time. Total abstinence is a very effective way to treat them to prevent the development of the final stage of this disease. In contrast, repetitive drinking of massive amount of alcohol is very harmful and causes exacerbation of this disease. From our clinical studies, six candidates were nominated as symptoms of alcoholic heart disease, namely(1) tachyarrhythmias (incidence: 33%), (2) left ventricular hypokinesis(17%), (3) QT interval prolongation(17%), (4) hyperthickened LV wall(13%), (5) LV dilatation with pump failure: alcoholic cardiomyopathy(0.1%), and (6) sudden cardiac death (unknown %). In the beginning of alcoholic heart disease, the patient usually complains of no symptoms, and physical signs are quite poor. Ordinarily, either transient atrial fibrillation and/or left ventricular hypertrophy which is initially documented by electrocardiography or echocardiography is one of the first signals in the diagnosis. Without such early signals, an early diagnosis is impossible. To make a definite diagnosis of alcoholic heart disease, a clinical follow-up is by all means necessary. Improvement of cardiac function after total abstinence, it's worsening after drinking again, and again improvement after abstinence a second time is a diagnostic clue. In this follow-up study, electrocardiography and echocardiography were employed as important ways to gather date. In treatment, total abstinence is essential. To achieve this therapeutic goal, education of the patient is necessary, because approximately 70 per cent of patients with alcoholic heart disease fail to continue abstinence within two years even if they have good training.     

Alcoholic heart disease

PREVIEW

Although essential tremor is common, its various presentations may be confused with other movement disorders, such as Parkinson's disease and dystonic tremor. In this article, Dr Evidente describes classify cation of tremor, the clinical features of essential tremor, and the differential diagnostic considerations. He also discusses the extensive list of medications used to treat the disorder and the surgical options for severe, drug-resistant cases.     

Alcoholic liver disease in Scotland and northeastern England: presenting features in 510 patients

A study of 510 patients in Scotland and northeastern England with histological evidence of alcohol-induced liver disease showed no difference in the age of presentation between males and females. Single men and widowed females were particularly susceptible to alcoholic liver disease. The social class distribution was similar to the population in general. Women were more reluctant to volunteer a history of alcoholism than men, they had a higher incidence of previous psychiatric illness (usually due to alcohol abuse) and they developed liver disease at lower consumption thresholds of alcohol than men. Patients under 40 years of age were more likely to have alcoholic fatty liver and less likely to have active cirrhosis than those over 40. Most often, the presenting symptoms were non-specific and tended to be related to the gastrointestinal system, particularly in women. Five per cent of patients were asymptomatic and 14% came to hospital for conditions other than alcoholic liver disease. Important clues to asymptomatic alcoholic liver disease included hepatomegaly, clubbing of the fingers and abnormal liver function tests. Gastro-oesophageal varices accounted for 40% of instances of haemorrhage and the mortality from upper gastrointestinal bleeding was 17%. Anaemia was the most common haematological abnormality. Alcoholic hepatitis was observed more frequently in the Glasgow area then elsewhere.     

Alcoholic liver disease in the intensive care unit: Outcomes and predictors of prognosis

Background

An increasing number of patients with alcoholic liver disease (ALD) are being referred for critical care support, but limited information is available on their short- and medium-term outcomes. This study aimed to determine mortality rates, identify optimal predictors of prognosis, and determine the appropriate time to apply these predictors in patients with ALD admitted to intensive care unit (ICU).

Methods

In this retrospective study, patients admitted to ICU between 2009 and 2012 with a primary diagnosis of ALD were included. Survival was calculated using the Kaplan-Meier method, risk factors for death determined by logistic regression analysis, and discriminative capacity of models using receiver operating characteristic curves.

Results

Of 170 patients admitted with liver disease, 62 met the inclusion criteria. Survival rates in the ICU, in hospital, and at 6 months were 40.3% (95% confidence interval [CI], 30.7%-49.9%), 35.5% (95% CI, 25.35%-45.65%), and 29% (95% CI, 19.4%-38.6%), respectively. Multiple linear regression analysis of day 1 variables produced an equation with Sequential Organ Failure Assessment score and lactate as significant predictors of mortality; this model had an area under the receiver operating characteristic curve of 0.93. A score greater than 12 in this model correlated with a mortality of more than 80% at all time points and was more accurate than any other score examined.

Conclusion

Patients admitted to ICU with ALD have a very high inhospital mortality. A combination of the established Sequential Organ Failure Assessment score and lactate provided the most accurate predictor of outcome on day of admission and at all subsequent time points.     

Alcoholic heart disease.

Alcohol has been suspected for many years of being a cause of heart disease. For a while its role was obscured by its association with beriberi heart disease and, more recently, by the toxic effect of cobalt in beer. Experimental studies, however, have provided convincing evidence of the primary role of alcohol itself. The mode of action is still in dispute. In the absence of specific findings, the diagnosis is made chiefly by exclusion of other known causes of heart disease and by a history of excessive alcohol intake over a number of years. The usual methods of treatment for the manifestations of heart failure, arrhythmias, and thromboembolic phenomena are important, but total abstinence from alcohol is the single essential factor. The sooner this is instituted, the better is the chance of interrupting the otherwise inexorable course to death.     

Alcoholic liver disease: Value of the left-to-right portal vein ratio in its sonographic diagnosis

A study group of 50 patients in whom the left portal vein diameter was equal to or greater than the right portal vein diameter (LPVDRPVD) was prospectively compared on ultrasonography with a control group of 50 patients with LPVD < RPVD. Clinical and laboratory data indicating chronic alcoholic liver disease (CALD) were observed with a significantly higher frequency in the study group than in the control group. It emerges from this study that LPVD RPVD represents a useful ultrasonographic sign of CALD, corresponding to a relative enlargement of the left hepatic lobe compared with the right.     

酒精性肝病的实验室诊断的临床研究

目的研究实验室诊断在酒精性肝病的诊断中临床应用价值。方法通过测定健康者、酒精性肝病患者、非酒精性肝病（甲肝、乙肝、肝硬化、肝癌）患者发病期（ALT≥65U／L）及治疗后（ALT≤65U／L）血液中天冬氨酸转氨酶同工酶（m-AST）、纤维结合蛋白（Fn）、γ-谷氨酰转移酶（r-GT）的变化进行分析。结果m-AST在ALD组和NALD组中的阳性检出率分别为75％与46％（P〈0．05）,Fn在ALD组和NALD组中的阳性检出率57％与60％（P〉0．05）,γ-GT在ALD组及NALD组中阳性检出率90％与88％（P〉0．05）;in-Asr在ALD组19．3±10．3U／L与对照组t检验P〈0．05与NALD组t检验P〈0．05;Fn在ALD组335。6±59．5mg／L与对照组t检验P〈0．05与NALD组t检验P〉0。05;r-GT在ALD组67．5±54．4U／L与对照组t检验P〈0．05与NALD组t检验P〉0．05;AID组治疗前后m-AST、Fn下降较为明显,经t检验P〈0．05说明治疗前后m-AST、Fn的结果有显著性差异。结论血清m-AST活性测定对有无活动性酒精性肝病有诊断和鉴别、及疗效有诊断价值;Fn的测定对早期判断酒精性肝病以及治疗疗效有一定价值,是判断病情严重程度、预后的良好指标;r-GT酶诊断酒精性损伤的敏感性甚高但γ-GT增高的特异性不高。