Etiopathogenesis=
.Alcohol intake..
Alcohol is metabolised by liver to acetaldehyde by mitochondrial enzyme,ADH.
Acetaldehyde forms adducts with cellular proteins in hepatocytes which activate immune system,leading to cell injury.
Acetaldehyde then metabolised to acetyl coA nd acetate by ALD,this generate NADH,which changes redox pontential of cell
Cytochrome CYP2E1 is induced by alcohol,which generates microsomal peroxidation leading to oxygen free radicals formatn leading to mitochondrial damage
.PATHOLOGY=
.Alcoholic hepatitis
.Lipogranuloma
.Neutrophil infiltratn
.Mallory hyaline
.Pericellular fibrosis
.Macrovesicular steatosis
.Fibrosis nd cirrhosis
.Central hyaline sclerosis
.C/F=
.Clinical syndrome of alcoholic liver disease=
.1..Fatty liver=
abnormal liver biochemistry ,normal/large liver
.2..Alcoholic hepatitis=
.Jaundice
.Malnutritn
.Hepatomegaly
.Portal hypertension features like ascites ,encephalopathy
.3..Cirrhosis=
.Stigmata of chr liver disease
.Large/normal liver
.Ascites
.Encephalopathy
.Hepatocellular carcinoma
INVESTIGATION =
.Clinical history frm pt abt alcohol misuse,duratn ,severity
.Biological markers in absense of anemia
.Raised GGT wil b elevated in hepatic steatosis nd fibrosis
.Unexplained rib fracture on chest x ray suggest alcohol misuse
.Presence jaundice suggest alcoholic hepatitis
.Liver biopsy
.Maddreys score by prothrombin time nd bilirubin give discriminant function
.MANAGEMENT=
.Cessatn of alcohol consumptn.Life long abstinence is best advice
.Treatment of complicatn of cirrhosis such as variceal bleeding ,ecephalopathy nd ascites
.Nutrition is imp nd enteral feeding via fine bore nasogastric tube needed.
.Corticosteroids r of valve in pt with severe alcoholic hepatitis
.Pentoxifylline,a weak anti TNFaction beneficial in sever alcoholic hepatitis
.Liver transplantation.
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