Difference between revisions of "Alcoholic liver disease natural history, complications and prognosis"

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__NOTOC__
 
__NOTOC__
 
{{Alcoholic liver disease}}
 
{{Alcoholic liver disease}}
{{CMG}}; {{AE}} {{MKA}} {{CP}}
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{{CMG}}; {{AE}} {{MKA}}
  
 
==Overview==
 
==Overview==
Alcoholic liver disease progresses through three stages (steatosis, alcoholic hepatitis, and cirrhosis) with the continued use of alcohol. Serious complications begin to occur with the development of alcoholic hepatitis, when [[portal hypertension]], [[coagulopathy|coagulopathies]], and intractable [[jaundice]]. Complications of [[cirrhosis]] include [[hepatic encephalopathy]] and [[hepatocellular carcinoma]]. Prognosis varies dependent on level of progression of illness, and whether treatment is given. Prognosis can be measured using laboratory values, and three prognostic scores: the MELD score, the Glasgow Alcoholic Hepatitis Score, and the ABIC score.
+
Alcoholic liver disease progresses through three stages ([[steatosis]], [[alcoholic hepatitis]], and [[cirrhosis]]) with the continued use of [[alcohol]]. Serious complications begin to occur with the development of [[alcoholic hepatitis]], when [[portal hypertension]], [[coagulopathy|coagulopathies]], and intractable [[jaundice]]. Complications of [[cirrhosis]] include [[hepatic encephalopathy]] and [[hepatocellular carcinoma]]. Prognosis varies dependent on level of progression of illness, and whether treatment is given. Prognosis can be measured using laboratory values, and three prognostic scores: The [[MELD Score|MELD score]], the Glasgow Alcoholic Hepatitis Score, and the ABIC score.
  
==Natural History==<ref name="pmid25548474">{{cite journal |vauthors=Ceni E, Mello T, Galli A |title=Pathogenesis of alcoholic liver disease: role of oxidative metabolism |journal=World J. Gastroenterol. |volume=20 |issue=47 |pages=17756–72 |year=2014 |pmid=25548474 |pmc=4273126 |doi=10.3748/wjg.v20.i47.17756 |url=}}</ref><ref name="pmid25920088">{{cite journal |vauthors=Mathurin P, Bataller R |title=Trends in the management and burden of alcoholic liver disease |journal=J. Hepatol. |volume=62 |issue=1 Suppl |pages=S38–46 |year=2015 |pmid=25920088 |pmc=5013530 |doi=10.1016/j.jhep.2015.03.006 |url=}}</ref><ref name="pmid19553649">{{cite journal |vauthors=Lucey MR, Mathurin P, Morgan TR |title=Alcoholic hepatitis |journal=N. Engl. J. Med. |volume=360 |issue=26 |pages=2758–69 |year=2009 |pmid=19553649 |doi=10.1056/NEJMra0805786 |url=}}</ref>
+
==Natural History==
*Alcoholic liver disease is thought to progress through three main histological stages with the continued use of alcohol.  
+
Significant aspects regarding natural history of alcoholic liver disease include:<ref name="pmid25548474">{{cite journal |vauthors=Ceni E, Mello T, Galli A |title=Pathogenesis of alcoholic liver disease: role of oxidative metabolism |journal=World J. Gastroenterol. |volume=20 |issue=47 |pages=17756–72 |year=2014 |pmid=25548474 |pmc=4273126 |doi=10.3748/wjg.v20.i47.17756 |url=}}</ref><ref name="pmid25920088">{{cite journal |vauthors=Mathurin P, Bataller R |title=Trends in the management and burden of alcoholic liver disease |journal=J. Hepatol. |volume=62 |issue=1 Suppl |pages=S38–46 |year=2015 |pmid=25920088 |pmc=5013530 |doi=10.1016/j.jhep.2015.03.006 |url=}}</ref><ref name="pmid19553649">{{cite journal |vauthors=Lucey MR, Mathurin P, Morgan TR |title=Alcoholic hepatitis |journal=N. Engl. J. Med. |volume=360 |issue=26 |pages=2758–69 |year=2009 |pmid=19553649 |doi=10.1056/NEJMra0805786 |url=}}</ref>
 +
*Alcoholic liver disease is thought to progress through three main [[histological]] stages with the continued use of [[alcohol]].  
 
*[[Steatosis]] is the first stage occuring when [[triglycerides]] accumulate in [[hepatocytes]].  
 
*[[Steatosis]] is the first stage occuring when [[triglycerides]] accumulate in [[hepatocytes]].  
 
*This is reversible with abstinence.  
 
*This is reversible with abstinence.  
*Steatohepatitis or alcoholic hepatitis is the next stage characterized by:
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*[[Steatohepatitis]] or [[alcoholic hepatitis]] is the next stage characterized by:
 
**Fatty change  
 
**Fatty change  
 
**[[Inflammation]]
 
**[[Inflammation]]
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**[[Necrosis]]
 
**[[Necrosis]]
 
*The last stage is [[cirrhosis]] which is characterized by:
 
*The last stage is [[cirrhosis]] which is characterized by:
**Dense and diffuse micronodular fibrosis.  
+
**Dense and diffuse micronodular [[fibrosis]].  
 
**This stage is irreversible, and is a risk factor for the development of [[hepatocellular carcinoma]].
 
**This stage is irreversible, and is a risk factor for the development of [[hepatocellular carcinoma]].
  
 
==Complications==
 
==Complications==
 
====Alcoholic hepatitis====
 
====Alcoholic hepatitis====
 +
Complications of [[alcoholic hepatitis]] include:<ref name="pmid25920088" /><ref name="pmid19553649" /><ref name="pmid27373616">{{cite journal |vauthors=Allampati S, Mullen KD |title=Long-Term Management of Alcoholic Liver Disease |journal=Clin Liver Dis |volume=20 |issue=3 |pages=551–62 |year=2016 |pmid=27373616 |doi=10.1016/j.cld.2016.02.011 |url=}}</ref><ref name="pmid20034030">{{cite journal |vauthors=O'Shea RS, Dasarathy S, McCullough AJ |title=Alcoholic liver disease |journal=Hepatology |volume=51 |issue=1 |pages=307–28 |year=2010 |pmid=20034030 |doi=10.1002/hep.23258 |url=}}</ref><ref name="pmid16508290">{{cite journal |vauthors=Adachi M, Brenner DA |title=Clinical syndromes of alcoholic liver disease |journal=Dig Dis |volume=23 |issue=3-4 |pages=255–63 |year=2005 |pmid=16508290 |doi=10.1159/000090173 |url=}}</ref><ref name="pmid23101987">{{cite journal |vauthors=Gaglio PJ, Gaglio PJ |title=Complications in patients with alcohol-associated liver disease who undergo liver transplantation |journal=Clin Liver Dis |volume=16 |issue=4 |pages=865–75 |year=2012 |pmid=23101987 |doi=10.1016/j.cld.2012.08.013 |url=}}</ref>
 
* [[Portal hypertension]] ([[ascites]], [[variceal bleeding]], [[hepatorenal syndrome]])
 
* [[Portal hypertension]] ([[ascites]], [[variceal bleeding]], [[hepatorenal syndrome]])
 
* [[Coagulopathy]]
 
* [[Coagulopathy]]
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====Cirrhosis====
 
====Cirrhosis====
 +
Complications of [[cirrhosis]] include:<ref name="pmid25920088" /><ref name="pmid19553649" /><ref name="pmid27373616" /><ref name="pmid20034030" /><ref name="pmid16508290" /><ref name="pmid23101987" />
 
* [[Hepatocellular carcinoma]]
 
* [[Hepatocellular carcinoma]]
 
* [[Hepatic encephalopathy]]
 
* [[Hepatic encephalopathy]]
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==Prognosis==
 
==Prognosis==
 
====Poor Prognostic Factors====
 
====Poor Prognostic Factors====
 +
Poor [[prognostic]] factors of alcoholic liver disease include:<ref name="pmid27373616" /><ref name="pmid20034030" /><ref name="pmid25206273">{{cite journal |vauthors=Torruellas C, French SW, Medici V |title=Diagnosis of alcoholic liver disease |journal=World J. Gastroenterol. |volume=20 |issue=33 |pages=11684–99 |year=2014 |pmid=25206273 |pmc=4155359 |doi=10.3748/wjg.v20.i33.11684 |url=}}</ref>
 
* Prolonged [[prothrombin time]]
 
* Prolonged [[prothrombin time]]
 
* Serum [[Bilirubin]] >10 mg/dL
 
* Serum [[Bilirubin]] >10 mg/dL
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* [[Azotemia]]
 
* [[Azotemia]]
 
* [[Leukocytosis]]
 
* [[Leukocytosis]]
* Unresponsive to steroid treatment
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* Unresponsive to [[steroid]] treatment
* Reversal portal flow on doppler USG
+
* Reverse portal flow on [[doppler ultrasound]]
  
 
====Prognostic Scores====
 
====Prognostic Scores====
 +
[[Prognostic]] scores used to assess the [[prognosis]] of patients with alcoholic liver disease include:<ref name="pmid27373616" /><ref name="pmid20034030" /><ref name="pmid25206273" />
 
* [[MELD score]] for [[cirrhosis]]
 
* [[MELD score]] for [[cirrhosis]]
* Glasgow alcoholic hepatitis score (age, [[white blood cell]], [[blood urea nitrogen]], [[prothrombin time]] ratio, and [[bilirubin]] level)
+
* Glasgow [[alcoholic hepatitis]] score (age, [[white blood cell]], [[blood urea nitrogen]], [[prothrombin time]] ratio, and [[bilirubin]] level)
 
* ABIC score - age, [[serum bilirubin]], [[serum creatinine]]
 
* ABIC score - age, [[serum bilirubin]], [[serum creatinine]]
  
 
==2010 AASLD/ACG Alcoholic Liver Disease Guidelines (DO NOT EDIT)<ref name="urlwww.aasld.org">{{cite web |url=http://www.aasld.org/practiceguidelines/Documents/Bookmarked%20Practice%20Guidelines/AlcoholicLiverDisease1-2010.pdf |title=www.aasld.org |format= |work= |accessdate=2012-10-27}}</ref>==
 
==2010 AASLD/ACG Alcoholic Liver Disease Guidelines (DO NOT EDIT)<ref name="urlwww.aasld.org">{{cite web |url=http://www.aasld.org/practiceguidelines/Documents/Bookmarked%20Practice%20Guidelines/AlcoholicLiverDisease1-2010.pdf |title=www.aasld.org |format= |work= |accessdate=2012-10-27}}</ref>==
 
===Prognostic factors : Guidelines (DO NOT EDIT)<ref name="urlwww.aasld.org">{{cite web |url=http://www.aasld.org/practiceguidelines/Documents/Bookmarked%20Practice%20Guidelines/AlcoholicLiverDisease1-2010.pdf |title=www.aasld.org |format= |work= |accessdate=2012-10-27}}</ref>===
 
===Prognostic factors : Guidelines (DO NOT EDIT)<ref name="urlwww.aasld.org">{{cite web |url=http://www.aasld.org/practiceguidelines/Documents/Bookmarked%20Practice%20Guidelines/AlcoholicLiverDisease1-2010.pdf |title=www.aasld.org |format= |work= |accessdate=2012-10-27}}</ref>===
{|class="wikitable"
+
{| class="wikitable"
 
|-
 
|-
| colspan="1" style="text-align:center; background:LightGreen"|[[AASLD guidelines classification scheme#Class of recommendation|Class I]]
+
| colspan="1" style="text-align:center; background:LightGreen" |[[AASLD guidelines classification scheme#Class of recommendation|Class I]]
 
|-
 
|-
| bgcolor="LightGreen"| '''1.''' <nowiki>"</nowiki> Patients presenting with a high clinical suspicion of alcoholic hepatitis should have their risk for poor outcome stratified using the Maddrey Discriminant Function (MDF), as well as other available clinical data. Evaluating a patient's condition over time with serial calculation of the Model for End-Stage Liver Disease (MELD) score is also justified. ([[AASLD guidelines classification scheme#Level of evidence|Level of evidence: B]]) <nowiki>"</nowiki>
+
| bgcolor="LightGreen" | '''1.''' <nowiki>"</nowiki> Patients presenting with a high clinical suspicion of alcoholic hepatitis should have their risk for poor outcome stratified using the Maddrey Discriminant Function (MDF), as well as other available clinical data. Evaluating a patient's condition over time with serial calculation of the Model for End-Stage Liver Disease (MELD) score is also justified. ([[AASLD guidelines classification scheme#Level of evidence|Level of evidence: B]]) <nowiki>"</nowiki>
 
|}
 
|}
  
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{{reflist|2}}
 
{{reflist|2}}
  
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[[Category:Surgery]]
 
[[Category:Gastroenterology]]
 
[[Category:Gastroenterology]]
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[[Category:Up-To-Date]]
 
[[Category:Hepatology]]
 
[[Category:Hepatology]]
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[[Category:Primary care]]
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[[Category:Medicine]]
  
 
{{WS}}
 
{{WS}}
 
{{WH}}
 
{{WH}}

Latest revision as of 19:54, 9 February 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: M. Khurram Afzal, MD [2]

Overview

Alcoholic liver disease progresses through three stages (steatosis, alcoholic hepatitis, and cirrhosis) with the continued use of alcohol. Serious complications begin to occur with the development of alcoholic hepatitis, when portal hypertension, coagulopathies, and intractable jaundice. Complications of cirrhosis include hepatic encephalopathy and hepatocellular carcinoma. Prognosis varies dependent on level of progression of illness, and whether treatment is given. Prognosis can be measured using laboratory values, and three prognostic scores: The MELD score, the Glasgow Alcoholic Hepatitis Score, and the ABIC score.

Natural History

Significant aspects regarding natural history of alcoholic liver disease include:[1][2][3]

Complications

Alcoholic hepatitis

Complications of alcoholic hepatitis include:[2][3][4][5][6][7]

Cirrhosis

Complications of cirrhosis include:[2][3][4][5][6][7]

Prognosis

Poor Prognostic Factors

Poor prognostic factors of alcoholic liver disease include:[4][5][8]

Prognostic Scores

Prognostic scores used to assess the prognosis of patients with alcoholic liver disease include:[4][5][8]

2010 AASLD/ACG Alcoholic Liver Disease Guidelines (DO NOT EDIT)[9]

Prognostic factors : Guidelines (DO NOT EDIT)[9]

Class I
1. " Patients presenting with a high clinical suspicion of alcoholic hepatitis should have their risk for poor outcome stratified using the Maddrey Discriminant Function (MDF), as well as other available clinical data. Evaluating a patient's condition over time with serial calculation of the Model for End-Stage Liver Disease (MELD) score is also justified. (Level of evidence: B) "

References

  1. Ceni E, Mello T, Galli A (2014). "Pathogenesis of alcoholic liver disease: role of oxidative metabolism". World J. Gastroenterol. 20 (47): 17756–72. PMC 4273126Freely accessible. PMID 25548474. doi:10.3748/wjg.v20.i47.17756. 
  2. 2.0 2.1 2.2 Mathurin P, Bataller R (2015). "Trends in the management and burden of alcoholic liver disease". J. Hepatol. 62 (1 Suppl): S38–46. PMC 5013530Freely accessible. PMID 25920088. doi:10.1016/j.jhep.2015.03.006. 
  3. 3.0 3.1 3.2 Lucey MR, Mathurin P, Morgan TR (2009). "Alcoholic hepatitis". N. Engl. J. Med. 360 (26): 2758–69. PMID 19553649. doi:10.1056/NEJMra0805786. 
  4. 4.0 4.1 4.2 4.3 Allampati S, Mullen KD (2016). "Long-Term Management of Alcoholic Liver Disease". Clin Liver Dis. 20 (3): 551–62. PMID 27373616. doi:10.1016/j.cld.2016.02.011. 
  5. 5.0 5.1 5.2 5.3 O'Shea RS, Dasarathy S, McCullough AJ (2010). "Alcoholic liver disease". Hepatology. 51 (1): 307–28. PMID 20034030. doi:10.1002/hep.23258. 
  6. 6.0 6.1 Adachi M, Brenner DA (2005). "Clinical syndromes of alcoholic liver disease". Dig Dis. 23 (3-4): 255–63. PMID 16508290. doi:10.1159/000090173. 
  7. 7.0 7.1 Gaglio PJ, Gaglio PJ (2012). "Complications in patients with alcohol-associated liver disease who undergo liver transplantation". Clin Liver Dis. 16 (4): 865–75. PMID 23101987. doi:10.1016/j.cld.2012.08.013. 
  8. 8.0 8.1 Torruellas C, French SW, Medici V (2014). "Diagnosis of alcoholic liver disease". World J. Gastroenterol. 20 (33): 11684–99. PMC 4155359Freely accessible. PMID 25206273. doi:10.3748/wjg.v20.i33.11684. 
  9. 9.0 9.1 "www.aasld.org" (PDF). Retrieved 2012-10-27. 



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