Write a short note on Alcoholic Liver Disease
Alcoholic liver disease is the term used to describe the spectrum of liver injury including sequential stages of steatosis, hepatitis and cirrhosis.
Risk factors: (Mneumonic: Good Morning CID )
- Genetic Factors: Genetic Polymorphism in MEOS(Microsomal P-450 oxidases) and Alcohol Dehydrogenase(ADH).
- Gender: Women have more susceptibility due to Estrogen.
- Malnutrition: Protein and Vitamin deficiencies
- Hepatitis C infection
- Infections: They accelerate Cirrhosis
- Drinking Patterns: ntermittent drinking for long duration is less harmful than acute ‘Binge’ drinking.
Pathogenesis:The pathogenesis for alcoholic liver disease involves number of factors:(Mneumonic : I FOR HER)
- Inflammation : Ethanol damages the intestinal cells during absorption which leads to release of Cytokines like TNF-alpha , IL-1 ,IL-6 ,TGF-beta which damage hepatocytes.
- Immunologic mechanism: Cell mediated immunity is impaired. Mallory bodies formed.
- Fat in liver: Increaesed fat accumulation in liver by alcohol leading to fatty changes.
- Fibrogenesis: Activation of Stellate Cells by Damaged Hepatocyte, Kupffer cells, Acetaldehyde, Malon-di-aldehyde-acetaldehyde
- Oxidative Stress: Free radicals generated by Cytochrome P-450 by MEOS metabolism.
- Redox ratio: Increased NADH:NAD ratio leads to lactic acidosis, fatty liver , collagen formation & gout.
- Hypoxia : Increased oxygen demand in hepatocytes > Centrilobular Necrosis.
- Ethanol: Directly damages Microtubule, Membrane of hepatocyte and Mitochondria.
- Ethanol metabolite : Acetaldehyde produced has significant toxic effect on liver cell by producing two substances Protein aldehyde adduct : Damages membrane, Malon Di-Aldehyde-Actetaldehyde adduct : Generates Autoimmune Response and also involves PPAR-Gamma ( Peroxisome Proliferator Activated Receptor).
- Retention of liver cell water and proteins: Alcohol inhibits the release of proteins and water from the hepatocyte leading to swelling up of the cell and Hepatomegaly.
MORPHOLOGICAL FEATURES:  Alcoholic Steatosis:
- Gross: Enlarged, Yellow, Greasy ,Firm, Smooth and glistening capsule.
- Microscopic: Micro and Macro Vesicular fat droplets, Fat Cysts and Lipogranulomas.
 Alcoholic Hepatits:
- Gross: Inflammatory, Red, Enlarged.
- Microscopic: Hepatocellular necrosis , Mallory bodies and Creeping Collagenosis.
 Alcoholic Cirrhosis:
- Gross: Micronodular cirrhosis (<3mm), Wt 3mm) , Nodules have Tawny Yellow appearance , Hobnail liver , Fibrous septa on cut-section.
- Microscopic: Nodular lobular architecture , Fibrous septa-Portal to portal or Potal to central vein , Mallory bodies ,Necrosis , Bille duct proliferation.
- Alcoholic Steatosis : Hepatomegaly
- Alcoholic Hepatitis : Malaise , Anorexia , Weight loss , Upper abdominal discomfort , Tender hepatomegaly.
- Alcoholic Cirrhosis : Malaise ,Anorexia ,Wt loss , Jaundice , Ascitis, Peripheral Edema , Caput Medusae , Wasted extremities ,Anemia , Hepatic Encephalopathy.
- Elevated SGOT & SGPT
- Elevated Gamma-Glutamyl transferase
- Elevated ALP.
- Reversal of A:G ratio
- Prolonged PT & aPTT.
- Decreased Hb
- Elevated TLC.
Author: Ridham Khanderia
- Textbook of Pathology by Harshmohan : 5th Edition , Jaypee 2011 , Chapter 21: The Liver , Biliary Tract and Exocrine , Page Num: 619-623
- The Pathologic Basis of Disease : Robbins and Cotran , 8th Edition, Elsevier 2011, Chap 16 : The Liver , Gallbladder and Biliary Tract , Page num : 648-652.