Alcoholic liver disease natural history, complications and prognosis

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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] Charmaine Patel, M.D. [3]

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[1][2][3]

  • 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.
  • This is reversible with abstinence.
  • Steatohepatitis or alcoholic hepatitis is the next stage characterized by:
  • The last stage is cirrhosis which is characterized by:
    • Dense and diffuse micronodular fibrosis.
    • This stage is irreversible, and is a risk factor for the development of hepatocellular carcinoma.

Complications

Alcoholic hepatitis

Cirrhosis

Prognosis

Poor Prognostic Factors

Prognostic Scores

2010 AASLD/ACG Alcoholic Liver Disease Guidelines (DO NOT EDIT)[4]

Prognostic factors : Guidelines (DO NOT EDIT)[4]

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. 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. 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 "www.aasld.org" (PDF). Retrieved 2012-10-27. 

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