Alcoholic liver disease natural history, complications and prognosis
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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.
- 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.
- Portal hypertension (ascites, variceal bleeding, hepatorenal syndrome)
- Intractable jaundice
Poor Prognostic Factors
- Prolonged prothrombin time
- Serum Bilirubin >10 mg/dL
- Hepatic encephalopathy
- Unresponsive to steroid treatment
- Reversal portal flow on doppler USG
- MELD score for cirrhosis
- Glasgow alcoholic hepatitis score (age, white blood cell, blood urea nitrogen, prothrombin time ratio, and bilirubin level)
- ABIC score - age, serum bilirubin, serum creatinine
2010 AASLD/ACG Alcoholic Liver Disease Guidelines (DO NOT EDIT)
Prognostic factors : Guidelines (DO NOT EDIT)
|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) "|
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