Alcoholic liver disease

Alcoholic liver disease is damage to the liver and its function due to alcohol disease.
Causes
Alcoholic liver disease occurs after years of heavy drinking. Alcohol can cause inflammation
in the liver. Over time, scarring and cirrhosis can occur. Cirrhosis is the final phase of
alcoholic liver disease.
Alcoholic liver disease does not occur in all heavy drinkers. The chances of getting liver
disease go up the longer you have been drinking and more alcohol you consume. You do not
have to get drunk for the disease to happen.
The disease seems to be more common in some families. Women may be more likely to
have this problem than men.
Pathophysiology
The liver and, to a lesser extent, the gastrointestinal tract, are the main sites of alcohol
metabolism. Within the liver there are 2 main pathways of alcohol metabolism: alcohol
dehydrogenase and cytochrome P-450 (CYP) 2E1. Alcohol dehydrogenase is a hepatocyte
cytosolic enzyme that converts alcohol to acetaldehyde. Acetaldehyde subsequently is
metabolized to acetate via the mitochondrial enzyme acetaldehyde dehydrogenase. CYP 2E1
also converts alcohol to acetaldehyde.4
Liver damage occurs through several interrelated pathways. Alcohol dehydrogenase and
acetaldehyde dehydrogenase cause the reduction of nicotinamide adenine dinucleotide
(NAD) to NADH (reduced form of NAD). The altered ratio of NAD/NADH promotes fatty liver
through the inhibition of gluconeogenesis and fatty acid oxidation. CYP 2E1, which is
upregulated in chronic alcohol use, generates free radicals through the oxidation of
nicotinamide adenine dinucleotide phosphate (NADPH) to NADP.4 Chronic alcohol exposure
also activates hepatic macrophages, which then produce tumor necrosis factor-alpha (TNFalpha).5 TNF-alpha induces mitochondria to increase the production of reactive oxygen
species. This oxidative stress promotes hepatocyte necrosis and apoptosis, which is
exaggerated in the alcoholic who is deficient in antioxidants such as glutathione and vitamin
E. Free radicals initiate lipid peroxidation, which causes inflammation and fibrosis.

Inflammation is also incited by acetaldehyde that, when bound covalently to cellular

proteins, forms adducts that are antigenic.4
SYMPTOMS
Symptoms vary, based on how bad the disease is. You may not have symptoms in the early
stages. Symptoms tend to be worse after a period of heavy drinking.
Digestive symptoms include:

Pain and swelling in the abdomen

Decreased appetite and weight loss

Nausea and vomiting

Fatigue

Dry mouth and increased thirst

Bleeding from enlarged veins in the walls of the lower part of the esophagus (tube
that connects your throat to your stomach)

Skin problems such as:

Yellow color in the skin, mucus membranes, or eyes (jaundice)

Small, red spider-like veins on the skin

Very dark or pale skin

Redness on the feet or hands

Itching

Brain and nervous system symptoms include:

Problems with thinking, memory, and mood

Fainting and lightheadedness

Numbness in legs and feet

TREATMENT

The most important part of treatment is to stop using alcohol completely. If liver cirrhosis
has not yet occurred, the liver can heal if you stop drinking alcohol.
An alcohol rehabilitation program or counseling may be necessary to break the alcohol
addiction. Vitamins, especially B-complex and folic acid, can help reverse malnutrition.
If cirrhosis develops, you may need to manage the complications of cirrhosis. You may need
a liver transplant . if there has been a lot of liver damage.

If you have fatty liver, or alcoholic hepatitis which is not severe, you should fully
recover from these conditions if you stop drinking alcohol.

If you have severe hepatitis and require hospital admission, you may require
intensive care treatment. Some people with severe hepatitis will die.

If you have cirrhosis, stopping drinking alcohol can improve your outlook. It depends
on how severe the cirrhosis has become. If cirrhosis is diagnosed when it is not too
advanced, and you stop drinking alcohol, the cirrhosis is unlikely to progress. However,
the cirrhosis and symptoms will usually get worse if you continue to drink alcohol. In
severe cases where the scarring is extensive, and the liver can barely function, then a
liver transplant may be the only option.

Prevention

Men should drink no more than 21 units of alcohol per week, no more than four units
in any one day, and have at least two alcohol-free days a week.

Women should drink no more than 14 units of alcohol per week, no more than three
units in any one day, and have at least two alcohol-free days a week.

Pregnant women. Advice from the Department of Health states that ... "pregnant
women or women trying to conceive should not drink alcohol at all. If they do choose to
drink, to minimise the risk to the baby, they should not drink more than 1-2 units of
alcohol once or twice a week and should not get drunk".

Signs of hepatic encephalopathy

Hepatic encephalopathy starts slowly. People with hepatic encephalopathy may

not even know they have it. To them, things seem fine. But things may not seem
fine to family or friends.
People with worsening hepatic encephalopathy may not be able to drive a car or
work a steady job. They may also need to rely on a caregiver to take care of
them. In serious cases, hospitalization, coma, and even death can occur.
MENTAL SIGNS:

Forgetfulness, mild confusion

Poor judgment

Being extra nervous or excited

Not knowing where they are or where they're going

Inappropriate behavior or severe personality changes

PHYSICAL SIGNS:

Breath with a musty or sweet odor

Change in sleep patterns (often awake at night and sleeping during the
day)

Worsening of handwriting or loss of other small hand movements

Movements or shaking of hands or arms

Slurred speech

Slowed or sluggish movement

Stahes of hepatic encephalopathy

Stage 1
Mildhepatic encephalopathy
Patients may have sleep problems and trouble concentrating. They may have
severe mood swings. Their hands might shake and they may have difficulty
writing. , the symptoms include short attention span, nightmares and poor night time sleep with
daytime sleepiness, restlessness, depression, aimless wandering, anxiety and irritability
Stage 2
Moderate hepatic encephalopathy

Patients may not have much energy. They keep forgetting things and have
problems with basic math. They may behave strangely and slur their speech. the
mental and personality changes include obvious drowsiness, obvious personality changes,
gross impairment of ability to do mental tasks, slowed response, disobedience, sullenness,
disorientation for time and place
Stage 3
Sever hepatic encephalopathy

Patients are very sleepy and sometimes pass out. They can't do basic math at
all. They act strange and can be very fearful and jumpy. , the symptoms include
bizarre behavior, occasional fits of rage, marked confusion, incomprehensible speech, paranoia
and anger.
Stage 4
Final stage

The final stage of hepatic encephalopathy is comathe patient is unconscious.

different types of hepatic encephalopath

Acute encephalopathy is generally rapidly progressive over a short course and is a complication
of acute liver disease. This type of HE is a sign of terminal liver failure and most often occurs in
patients with acute fulminant viral hepatitis, toxic hepatitis and Reyes syndrome
Chronic cerebral degeneration and myelopathy are possibly permanent neurological
abnormalities that are unresponsive to therapy. This condition is very rare. Patients can have
difficulty with balance and walking. Occasionally, tremors similar to Parkinsons disease can
also be prevent

Chronic encephalopathy involves multiple recurrences of observable HE. It requires continuous

therapy to decrease or prevent the development of symptoms during intervening periods.
Usually, this type of HE is found in patients who have cirrhosis with extensive portal collateral
circulation with surgically-created or spontaneously-evolving shunts. In between obvious
episodes, HE can be subtle and low-grade such that it may not be noticeable. Chronic HE is a
sign of significant decompensation from cirrhosis.

Chronic cerebral degeneration and myelopathy are possibly permanent neurological

abnormalities that are unresponsive to therapy. This condition is very rare. Patients can have
difficulty with balance and walking. Occasionally, tremors similar to Parkinsons disease can also
be present