Alcohol Liver Disease: Review

Abstract

More, than last anniversary occurs dramatically increase hospital admission of patients with alcoholic liver disease
(ALD). Although there is a clear relationship between the risk of ALD and the dose of alcohol consumed, additional
risk factors include genetic predisposition, gender, nutritional status, obesity, and co-existing liver diseases such as
hepatitis C. ALD ranges from steatosis to alcoholic steatohepatitis and established cirrhosis. Several mechanisms are
involved in the pathophysiology of ALD, including oxidative damage secondary to alcohol metabolism, and endotoxaemia leading to tumour necrosis factor a-mediated cell damage and death. Diagnosis requires a combination of a
history of alcohol excess, clinical evidence of liver dis- ease and compatible laboratory investigations, and the exclusion of other liver diseases. Liver biopsy may be necessary in cases of uncertainty. Presentation varies from incidental blood test abnormalities through to overt liver failure. The key to management is longterm abstinence and
care should be delivered in conjunction with addiction services. Proteinecalorie malnutrition is common and should
be addressed along with specific thiamine replacement. Acute severe alco- holic hepatitis has a high mortality, and
prognostic scores, such as the discriminant function and the Glasgow alcoholic hepatitis score, have been derived to
identify those at highest risk and those who may derive short-term benefit from treatment with corticosteroids. Cirrhotic patients require hepatoma screening and variceal screening endoscopy. Liver transplant should be considered
if the clinical condition does not improve despite a period of abstinence.