Alcohol consumption is high in most Western countries. The male:female ratio is about 2:1. Disorders that occur in alcohol abusers, often in sequence, include
• Fatty liver (in > 90%)
• Alcoholic hepatitis (in 10 to 35%)
• Cirrhosis (in 10 to 20%)
The main causative factors in alcohol-induced liver damage are
• Quantity and duration of alcohol use
Among susceptible people, a linear correlation generally exists between the amount and duration of alcohol use and the development of liver disease. Risk increases markedly for men who drink > 40 g, particularly >80 g, of alcohol/day for >10 years.
Women are more susceptible to alcoholic liver disease, even after adjustment for body size. Women require only 20 to 40 g of alcohol to be at risk.
• Genetic and metabolic traits
Alcoholic liver disease often runs in families, suggesting genetic factors (eg, deficiency of cytoplasmic enzymes that eliminate alcohol).
• Nutritional status
Under nutrition, particularly protein-energy under nutrition, increases susceptibility, as does a diet high in unsaturated fat.
- Other factors
Other risk factors include iron accumulation in the liver and concomitant hepatitis C.
Fatty liver, alcoholic hepatitis and cirrhosisare often considered separate, progressive manifestations of alcoholic liver disease.However, their features often overlap.
Symptoms and Signs
Symptoms usually become apparent in patients during their 30s or 40s; severe problems appear about a decade later.Fatty liver is often asymptomatic. In one-third of patients, the liver is enlarged and smooth, but it is not usually tender.Alcoholic hepatitis ranges from mild and reversible to life threatening. Most patients with moderate disease are under nourished and present with fatigue, fever, jaundice,right upper quadrant pain, tender hepatomegaly, and sometimes a hepaticbruit. About 40% deteriorate soon after hospitalization, with consequences ranging from mild (eg, increasing jaundice)to severe (eg, ascites, portal-systemicencephalopathy, variceal bleeding, liver failure with hypoglycemia, coagulopathy).
• Confirmed history of alcohol use
• Liver function tests and CBC
• Liver biopsy
Alcohol is suspected as the cause of liver disease in any patient who chronically consumes excess alcohol, particularly> 80 g/day. There is no specific test for alcoholic liver disease, but if the diagnosisis suspected, liver function tests (PT and serum bilirubin, aminotransferase, and albumin levels) and CBC are done to detect signs of liver injury and anemia.Elevations of aminotransferases are moderate (< 300 IU/L) and do not reflect the extent of liver damage. The ratio of AST to ALT is ≥ 2. The basis for low ALT is a dietary deficiency of pyridoxalphosphate (vitamin B6), which is needed for ALT to function. Its effect on AST isless pronounced.