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Alcoholic Liver Disease
Produces
Pathology
- Fatty change
- mainly zone 3
- steatosis (accumulation of lipids within hepatocytes)
- also seen in obesity, diabetes, starvation, chronic illness
- disappears on stopping alcohol
- Alcoholic hepatitis
- infiltration by PMN
- hepatocyte necrosis in zone 3
- Mallory bodies
- Alcoholic Cirrhosis
- classically micronodular
- may be of mixed type
Clinical Features
- fatty liver
- Hepatomegaly + signs
of
- Vomiting, nausea, vague abdominal discomfort, diarrhoea due to effects
of Alcohol on GI tract
- Alcoholic hepatitis
- may be few symptoms
- may be mild/moderate signs ill health
- may be severe
- History
- ill
- jaundice
- ascites
- abdominal pain
- high fever
- Examination
- Cirrhosis
Investigations
- Fatty liver
- FBC
- LFTs
- increased ALT/AST
- increased gamma-GT
- USS / CT
- Liver biopsy
- Alcoholic hepatitis
- FBC
- LFTs
- raised bilirubin
- raised AST / ALT
- raised Alk. Phos.
- Clotting
- Albumin reduced
- (rarely) Zieve's Syndrome
- hyperlipidaemia + haemolysis
- Cirrhosis
Management
- stop drinking
- bed rest
- diet
- high in protein + vitamins
- Alcoholic hepatitis
- Cirrhosis
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