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 (TNF-alpha).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 coma—the 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 Reye’s 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 Parkinson’s 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 Parkinson’s disease can also be present