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ALCOHOL AND THE LIVER

ALCOHOL AND THE LIVER. Prof JH VAN ZYL Dept Internal Medicine. Safe limits for alcohol intake. Males = 21 units per week (1 unit = glass or half pint Females = 14 units per week (1 Pint = .568l). Factors increasing susceptibility to ALD.

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ALCOHOL AND THE LIVER

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  1. ALCOHOL AND THE LIVER • Prof JH VAN ZYL • Dept Internal Medicine

  2. Safe limits for alcohol intake • Males = 21 units per week (1 unit = glass or half pint • Females = 14 units per week (1 Pint = .568l)

  3. Factors increasing susceptibility to ALD • Lifetime intake of alcohol • Female sex • Genetic factors • Drinking without food • Binge drinking • High concentration alcoholic drinks—for example, spirits • Drinking multiple different alcoholic beverages

  4. Major classification of ALD • Alcoholic fatty liver (steatosis) • Acute alcoholic hepatitis • Alcoholic cirrhosis

  5. Histological features of ALD • Steatosis (fatty liver) • Mallory's hyaline bodies • Cholestasis • Liver fibrosis • Micronodular cirrhosis

  6. Putative pathogenic mechanisms • Lipid peroxidation • Reduced antioxidant defences • Immunological • Iron deposition

  7. Clinical features • Nausea • Abdominal discomfort • Diarrhoea • Jaundice • Ascites • Encephalopathy • Upper gastrointestinal bleeding

  8. CAGE questionnaire • C.  Have you ever felt the need to cut down your drinking? • A.  Have you ever felt annoyed by criticism of your drinking? • G.  Have you ever felt guilty about your drinking? • E.  Have you ever taken a drink (eye opener) first thing in the morning? • Score 1 for each positive response. A score of 2 or more suggests alcohol excess

  9. Investigations • γ-Glutamyltransferase • Mean corpuscular volume • Carbohydrate deficient transferrin • Bilirubin (markedly raised in acute alcoholic hepatitis) • Serum transaminases: if greater than five times normal suspect other liver pathology • Prothrombin time • Albumin • Serum fibrosis markers: procollagen III propeptide, laminin, type IV collagen • Liver ultrasound: also detect splenomegaly and ascites • Liver biopsy

  10. Management • Abstinence: support groups, opiate antagonists, acamprosate • Vitamins: thiamine, folic acid, and other B vitamins • Nutrition supplements: nasogastric feeding in malnourished • Corticosteroids for severe acute alcoholic hepatitis • Standard treatment for decompensation features such as hypoglycaemia, ascites, varices, infections, encephalopathy, renal failure, and coagulopathy • Liver transplantation

  11. Research treatments • Propylthiouracil • Malotilate • S-adenosyl--methionine • Saturated fatty acids • Oxandrolone • Soya bean lecithin • Thalidomide • Monoclonal anti-TNF antibodies

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