Alcoholic Liver Disease Concise Medical Knowledge

Alcoholic fatty liver disease is the earliest stage of alcohol-related liver disease. This procedure remains the standard of care for patients with end-stage liver disease. As a result, transplantation candidates with ALD often are screened for common malignancies and must undergo a formal medical and psychiatric evaluation. They also must abstain from alcohol for 6 months before being considered for liver transplantation. Data show that fewer than 20 percent of patients with histories of alcohol use as the primary cause of end-stage liver disease receive liver transplants (Lucey 2014).

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The appearance of fat in the liver is highly variable on US, however, in general, a fatty liver will have a hyperechoic texture and macroscopic fat will appear as hyperechoic masses121. The sensitivity and specificity of a hyperechoic pattern on ultrasound for hepatic steatosis in patients with a liver replaced by at least thirty percent steatosis is 91% and 93% respectively. In patients who have less than thirty percent hepatic steatosis, the sensitivity is only approximately 64%122. Patients with ALD frequently demonstrate evidence of iron overload as reflected by elevated serum iron indices (ferritin and transferrin saturation) and hepatic iron concentration75,78. Nearly 30% of patients with ALD have increased hepatic iron stores79 and serum transferrin saturation may approach or even exceed 60% in some cases80.

Mechanisms Involved in Alcoholic Hepatitis

However, it is important to rule out other etiologies for the patient’s liver disease before making a definitive diagnosis of ALD, including chronic viral hepatitis, autoimmune hepatitis, hemochromatosis and drug related hepatotoxicity. In some cases, when the diagnosis is unclear, a liver biopsy may be warranted. One of the most common symptoms of Alcoholic Liver Disease is abdominal pain and tenderness. This discomfort may be accompanied by swelling or bloating in the abdominal area.

• In addition, all current mouse models of ALD generate mild-to-moderate liver injury, inflammation, and fibrosis or fibrotic responses.
• Factors such as genetic predisposition, overall health status, and even gender can play a role in determining an individual’s susceptibility to this condition.
• Most patients are diagnosed at advanced stages and data on the prevalence and profile of patients with early disease are limited.
• For example, HCV proteins induce oxidative stress by binding to the outer membranes of mitochondria, stimulating electron transport and increasing the generation of cellular ROS (e.g., superoxide) (Otani et al. 2005).

Transplantation

The combination of metabolic dysfunction and heavy alcohol consumption in this unique patient population exhibits overlapping and distinct mechanisms of liver disease progression which have been recently reviewed (145). As the rates of metabolic dysfunction are increasing in populations across the world, MetALD should be a priority for study going forward. Over the last 20 years, many molecular mechanisms have been identified that may contribute to the pathogenesis of ALD (18), but translation of these mechanisms to therapeutic targets needs further attention. For example, alcohol consumption causes adipose inflammation, lipolysis, and damage, which likely contribute to ALD pathogenesis (82, 83). Several therapies targeting ROS have shown mixed effects for sAH treatment, with N-acetyl cystine (NAC) providing no benefit (86, 87) and metadoxine providing modest alcoholic liver disease survival benefits (88). Autophagy has been shown to play an important but complex role in the pathogenesis of liver diseases, including ALD (89, 90), but has not been tested clinically as a therapeutic target for ALD due to its highly complex, cell-specific roles (91).

Alcohol’s Effects on Other Liver Cell Types

Symptoms include weight loss, fatigue, muscle cramps, easy bruising, and jaundice. The most common sign of alcoholic hepatitis is yellowing of the skin and whites of the eyes, called jaundice. The yellowing of the skin might be harder to see on Black and brown people. If you have cirrhosis, the damage to your liver is no longer reversible. If this is a safe option for you, you’ll join a national waiting list to get a liver transplant.

• ALT, alanine aminotransferase; AST, aspartate aminotransferase; INR, International Normalized Ratio.
• More data are available regarding the treatment of severe alcoholic hepatitis by enteral nutrition.
• The National Institute on Alcohol Abuse and Alcoholism defines heavy drinking as having 5 or more drinks in 1 day on at least 5 days out of the past month.
• If you notice early signs of alcohol-related liver disease, be sure to follow up with your doctor.
• Treatment also consists of evaluation for other risk factors that can damage the liver or put the liver at higher risk, such as infection with hepatitis C and metabolic syndrome.
• The USPSTF prefers the use of alcohol use disorders identification test (AUDIT), AUDIT-consumption (AUDIT-C) and single question screening in the primary care setting.

Hepatic encephalopathy.

As the rates of obesity, type 2 diabetes, and high cholesterol are rising in the United States, so is the rate of NAFLD. Alcohol use constitutes a huge economic and population burden in the United States and worldwide. Despite the known hepatotoxic effect of alcohol use, the field lacks availability of effective safe pharmacotherapies for management of ALD patients. With growing interest of drug addiction the research community and increasing funding from National Institute of Alcoholism and Alcohol Abuse and other organizations, the future holds promise for overcoming some of these urgent unmet clinical needs in this field (Table 5). Patients with ALD are suffering from two different disorders, namely AUD and liver disease. Hence, the treatment should involve integrated management targeting both the disorders.