Questions

Pathology

Pathology's Questions

Neuros

Neuros

July 30 2014

Alcohol Liver

Write a short note on Alcoholic Liver Disease

Neuros
Neuros
July 30 2014 #

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 )

  1. Genetic Factors:  Genetic Polymorphism in MEOS(Microsomal P-450 oxidases) and Alcohol Dehydrogenase(ADH).
  2. Gender: Women have more susceptibility due to Estrogen.
  3. Malnutrition:  Protein and Vitamin deficiencies
  4. Hepatitis C infection
  5. Infections: They accelerate Cirrhosis
  6. 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) 

  1. 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.
  2. Immunologic mechanism: Cell mediated immunity is impaired. Mallory bodies formed.
  3. Fat in liver: Increaesed fat accumulation in liver by alcohol leading to fatty changes.
  4. Fibrogenesis: Activation of Stellate Cells by Damaged Hepatocyte, Kupffer cells, Acetaldehyde,  Malon-di-aldehyde-acetaldehyde
  5. Oxidative Stress: Free radicals generated by Cytochrome P-450 by MEOS metabolism.
  6. Redox ratio: Increased NADH:NAD ratio leads to lactic acidosis, fatty liver , collagen formation & gout.
  7. Hypoxia : Increased oxygen demand in hepatocytes > Centrilobular Necrosis.
  8. Ethanol: Directly damages Microtubule, Membrane of hepatocyte and Mitochondria.
  9. 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).
  10. 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: [1] Alcoholic Steatosis:

  • Gross: Enlarged, Yellow, Greasy ,Firm, Smooth and glistening capsule.
  • Microscopic: Micro and Macro Vesicular fat droplets, Fat Cysts and Lipogranulomas.

[2] Alcoholic Hepatits:

  • Gross: Inflammatory, Red, Enlarged.
  • Microscopic: Hepatocellular necrosis , Mallory bodies and Creeping Collagenosis.

[3] 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.
 CLINICAL FEATURES:

  • 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.
 LABORATORY DIAGNOSIS:

  1. Elevated SGOT & SGPT
  2. Elevated Gamma-Glutamyl transferase
  3. Elevated ALP.
  4. Hyperbilirubinemia
  5. Hypoproteinemia
  6. Reversal of A:G ratio
  7. Prolonged PT & aPTT.
  8. Decreased Hb
  9. Elevated TLC.

Author: Ridham Khanderia

REFERENCES:

  1. Textbook of Pathology by Harshmohan : 5th Edition , Jaypee 2011 , Chapter 21: The Liver , Biliary Tract and Exocrine , Page Num: 619-623
  2. The Pathologic Basis of Disease : Robbins and Cotran , 8th Edition, Elsevier 2011, Chap 16 : The Liver , Gallbladder and Biliary Tract , Page num : 648-652.