PDF Clinical Hepatology: History · Present State · Outlook

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Blood tests can establish alcohol as the cause of the disease but cannot determine the seriousness of the illness. Aminotransferase abnormalities are usually indicative of ALD.

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There is increased serum activity of gamma glutamyl transpeptidase GGTP in chronic alcohol users. Serum electrolytes, mean corpuscular volume MCV and serum uric acid levels are also indicative of ALD in combination with results from other tests. Prothrombin time ability of the blood to clot may be indicative of mild hepatic disease, but may be present in hepatic failure.

Liver biopsy is not always necessary to confirm the diagnosis of ALD, but is the most sensitive measure of disease stage and is useful in predicting the disease course. Abdominal ultrasound and CT scanning may also be performed. Abdominal ultrasound is useful in the assessment of fatty content of the liver. CT scanning detects cirrhosis, portal hypertension and tumors. A liver biopsy is usually performed as an outpatient in a hospital or a GI clinic. The patient is instructed to have nothing by mouth for at least six hours prior to the procedure. After a sedative and local anesthetic is administered, a needle is inserted through the skin and into the body of the liver.

Small pieces of liver tissue are extracted for microscopic examination. A pressure dressing is applied to the site. The patient is monitored for signs and symptoms of bleeding during and usually discharged within 3 to 6 hours. The most important aspect of treatment in ALD is the immediate and total abstinence from alcohol. This does not need to be accomplished within the confines of a hospital, although efforts to enroll these patients in a detoxification program are clearly justified.

Hospitalization may be necessary for those patients who have extrahepatic complications or those with risks factors associated with acute liver-related mortality. Drugs may be used to treat the symptoms of withdrawal. Proteins and vitamin dietary supplements are prescribed. Vitamin B and K are administered.

Potassium, magnesium and zinc are administered to those patients with decompensated liver disease. Corticosteroids are prescribed for severely ill patients. This group of patients, with a high risk of mortality, has been found to have high levels of circulating pro-inflammatory cytokines. These are blocked by steroids, which have an anti-inflammatory effect. Pentoxifylline prevents worsening of renal function in patients with severe alcoholic hepatitis. Orthotopic liver transplantation improves survival rates in decompensated liver cirrhosis.

Currently, ALD is the single most common indication for transplantation in adults in the United States. However, considering the scarcity of donors and the financial expenditure, most transplant centers require a documented period of abstinence from alcohol usually six to 12 months. Complications of ALD are usually caused by the systemic complications of hepatic injury.

These include portal hypertension, an obstruction of the normal blood flow through the liver and reduction in functional hepatocyte mass. These conditions may occur in those with alcoholic hepatitis or alcoholic cirrhosis and in other non-alcohol related liver diseases. Portal hypertension results in an elevation in pressure throughout the vascular tree above the portal vein. This elevation in pressure may cause the formation of ascites accumulation of serous fluid in the abdomen and increased blood flow through alternative pathways resulting in the development of varices and hypersplenism.

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Spontaneous bacterial peritonitis may occur in the acutely ill cirrhotic patient. Reduction in functional liver mass causes hepatic encephalopathy mental dysfunction caused by an accumulation of nitrogenous wastes in the blood and brain , coagulopathy dysfunctional clotting mechanism due to decreased synthesis of clotting factors and hypoalbuminemia decreased synthesis and hepatic secretion of albumin, a protein responsible for maintaining serum osmotic pressure. When albumin content is decreased, the water tends to move out of serum into the tissues edema or swelling or into the peritoneal space area surrounding organs in the abdomen or ascites.

The treatment for ascites is salt restriction and careful diuresis fluid removal through the use of drugs that cause the patient to excrete large volumes of urine.

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