Alcoholic liver disease natural history, complications and prognosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Natural History

Alcoholic liver disease is thought to progress through three main histological stages with the continued use of alcohol. Steatosis is the first stage occuring when triglycerides accumulate in hepatocytes. This is reversible with abstinence. Steatohepatitis or alcoholic hepatitis is the next stage characterized by fatty change as well as inflammation, hepatocellular injury, and necrosis. The last stage is cirrhosis which is characterized by dense and diffuse micronodular fibrosis. This stage is irreversible, and is a risk factor for the development of hepatocellular carcinoma.

Complications

Alcoholic hepatitis

  • Portal hypertension (ascites, variceal bleeding, hepatorenal syndrome)
  • Coagulopathy
  • Intractable jaundice

Cirrhosis

Prognosis

In absence of steroid therapy, 1 in every three patient dies.

Poor Prognostic Factors

Prognostic Scores

  • MELD score for cirrhosis
  • Glasgow alcoholic hepatitis score (age, white blood cell, blood urea nitrogen, prothrombin time ratio, and bilirubin level)
  • ABIC score - age, serum bilirubin, serum creatinine

2010 AASLD/ACG Alcoholic Liver Disease Guidelines : Prognostic Factors (DO NOT EDIT)[1]

Class I
1. " Patients presenting with a high clinical suspicion of alcoholic hepatitis should have their risk for poor outcome stratified using the Maddrey Discriminant Function (MDF), as well as other available clinical data. Evaluating a patient's condition over time with serial calculation of the Model for End-Stage Liver Disease (MELD) score is also justified. (Level of evidence: B) "

References

  1. "www.aasld.org" (PDF). Retrieved 2012-10-27.

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