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Liver Disease—Alcoholic Hepatitis/Cirrhosis
Published in Charles Theisler, Adjuvant Medical Care, 2023
Cirrhosis can result from any cause of chronic liver inflammation, but is primarily due to alcoholic hepatitis, NASH, or the hepatitis C virus.3 The spectrum of alcoholic liver disease encompasses several conditions so that a single patient may be affected by fatty liver, and/or alcoholic hepatitis, and/or alcoholic cirrhosis. Symptoms of liver toxicity are right upper abdominal pain, jaundice (yellowing of the skin and whites of the eyes), itching, fatigue, loss of appetite, weight loss, and dark or tea-colored urine. Alcoholic hepatitis can lead to scarring, or cirrhosis, of the liver and ultimately liver failure.
A lawyer with a drink problem
Published in Tim French, Terry Wardle, The Problem-Based Learning Workbook, 2022
Liver biopsy is indicated in patients in whom the diagnosis of alcoholic hepatitis is uncertain based upon clinical and laboratory findings. Patients who may have more than one type of liver disease (such as alcohol-related disease and hepatitis C) may benefit from a liver biopsy to help determine the relative contribution of the different causes.
Gastroenterology
Published in Kaji Sritharan, Jonathan Rohrer, Alexandra C Rankin, Sachi Sivananthan, Essential Notes for Medical and Surgical Finals, 2021
Kaji Sritharan, Jonathan Rohrer, Alexandra C Rankin, Sachi Sivananthan
Alcohol may cause a number of problems of increasing severity in the liver: Alcoholic steatosis – fatty change, reversible if patient stops drinking.Alcoholic hepatitis – may present acutely with jaundice, tender hepatomegaly, vomiting, fever and general malaise.Alcoholic cirrhosis.InvestigationsAbnormal LFTs: raised bilirubin, AST >ALT, GGT; raised serum ferritin.Liver biopsy.ManagementAbstinence from alcohol (and if acute presentation, treatment of withdrawal).Treatment of complications of cirrhosis.Surgery: consider liver transplantation in select cases.
Multifactorial jaundice and pigmented choledocholithiasis secondary to warm autoimmune hemolytic anemia and alcoholic cirrhosis
Published in Baylor University Medical Center Proceedings, 2022
Colten Watson, Mazen Hassan, Grant Breeland
In warm autoimmune hemolytic anemia (w-AIHA), the body creates the autoantibodies IgG1 and IgG3 that can bind and lyse red blood cells, causing anemia.1 These autoantibodies, called hemolysins, can be detected with a Coombs test and confirmed with a direct antiglobulin test. Alcoholic cirrhosis presents with several of the same features, such as extreme jaundice and constitutional symptoms. It usually presents in the fifth to sixth decade of life in the setting of excessive chronic ethanol ingestion. Most evidence supporting ethanol consumption as an etiology for cirrhosis has come from epidemiological studies. The overwhelming cause of acute jaundice in patients with alcohol abuse is acute alcoholic hepatitis. The pathogenesis of alcoholic hepatitis is attributed mainly to the expression of cytokines, oxidative stress, reactive oxygen species, and SREBPs and SREBP-1, which impair fatty acid oxidation. Abstinence remains the most effective treatment method.2 The combination of alcoholic cirrhosis with w-AIHA in patients is not well documented in the medical literature.
Changes in the fecal bacterial microbiota associated with disease severity in alcoholic hepatitis patients
Published in Gut Microbes, 2020
Sonja Lang, Bradley Fairfied, Bei Gao, Yi Duan, Xinlian Zhang, Derrick E. Fouts, Bernd Schnabl
Alcohol-associated liver disease includes a wide spectrum of hepatic clinical syndromes and pathologic findings associated with heavy alcohol consumption1. Approximately 1 in 20 deaths worldwide is attributed to alcohol abuse, and alcohol-associated liver disease resulted in over 22,000 deaths in the US alone in 2017.2 Alcohol-associated liver disease includes steatosis, fibrosis, cirrhosis, and alcoholic hepatitis. These clinical entities, despite discrete definition, have substantial overlap and are closely interrelated. Simple steatosis involves fatty infiltration of the liver and is typically asymptomatic with normal or mild elevation in liver transaminases. A subset of these patients will go on to develop liver fibrosis, and ultimately, alcoholic cirrhosis. Alcoholic hepatitis is its own separate entity, which is related to but does not lie within the linear spectrum of steatosis, fibrosis, and cirrhosis in any predictable way. Thirty to 40% of chronic heavy drinkers will develop alcoholic hepatitis, but there is no clear identifiable trigger.3 Within alcoholic hepatitis, there is a wide range of disease severity, ranging from chronic and clinically silent to a fulminant syndrome of inflammation and cholestasis. Prognosis in alcoholic hepatitis varies widely, but is generally poor, with 30-day mortality reaching up to 50%.4
Increase in the incidence of alcoholic pancreatitis and alcoholic liver disease in Iceland: impact of per capita alcohol consumption
Published in Scandinavian Journal of Gastroenterology, 2020
Kristjan Hauksson, Margret Arnardottir, Arnar S. Agustsson, Berglind A. Magnusdottir, Maria B. Baldursdottir, Sigrun H. Lund, Evangelos Kalaitzakis, Einar S. Björnsson
Alcohol has been shown to be toxic to many parts of the body such as the central and peripheral nervous system, heart, bone marrow, the liver and the pancreas to name a few [1]. In a given patient the association is often strong but this is not always evident at the population level. Some previous studies have shown a positive relationship between increased alcohol consumption among the general population and mortality from liver cirrhosis [2–4]. Mortality from alcoholic cirrhosis in these studies has been based on registry data and information obtained from death certificates. It has been well documented that alcohol related deaths are underreported and particularly mortality from alcoholic cirrhosis [2,5]. Studies on the relationship between alcohol consumption and the incidence of alcoholic liver disease (ALD) are largely lacking. Furthermore, previous studies have analyzed mainly cirrhosis and have not included patients with alcoholic hepatitis which also leads to significant morbidity and mortality [6]. The annual incidence of cirrhosis has been shown to be very low in Iceland [7,8] compared to Sweden [8] and particularly with Denmark showing the highest incidence of alcoholic cirrhosis in the Scandinavian countries [9]. However, alcohol consumption has increased significantly in Iceland during the last decades [10–12].