Alcoholic Liver Disease

Snapshot

A 55-year-old man presents to his primary care physician for an annual examination. He currently does not have any acute complains; however, he continues drinking multiple alcoholic beverages daily. He noticed when he tries to stop drinking alcohol, he becomes tremulous and feels anxious. Laboratory studies demonstrate a transaminitis. An abdominal ultrasound demonstrates hepatic steatosis.

Introduction

Overview
- excessive alcohol use can lead to
  - alcoholic fatty liver disease
  - alcoholic hepatitis
  - cirrhosis
Pathophysiology
- ethanol consumption leads to
  - promotion of lipid accumulation within the liver
  - liver cell injury due to increased oxidative stress
  - decreased intake of vitamins
- ethanol metabolism leads to the production of
  - acetaldehyde
  - reduced nicotinamide adenine
Associated conditions
- malnutrition
  - Wernicke encephalopathy
  - Korsakoff syndrome
hepatic encephalopathy

Presentation

Patients are typically asymptomatic
- symptoms depend how severe the liver damage is and if the patient developed cirrhosis
Symptoms/physical exam
- palmar erythema
- gynecomastia
- testicular atrophy
- spider angiomas
- jaundice
- caput medusae
hematemesis or melena

Imaging

Abdominal ultrasound
- indication
to evaluate liver morphology, which may demonstrate hepatic steatosis or cirrhosis

Studies

Differential

Viral hepatitis
- differentiating factors
  - significantly elevated AST and ALT
positive hepatitis testing

Treatment

Complications