Alcoholic Liver Disease

Alcoholic liver disease is among the top ten causes of mortality in the US with somewhat higher mortality rates in western European countries where wine is considered a dietary staple, and is a leading cause of death in Russia. Among the three stages of alcoholic liver disease, fatty liver is related to the acute effects of alcohol on hepatic lipid metabolism and is completely reversible. By contrast, alcoholic hepatitis usually occurs after a decade or more of chronic drinking, is associated with inflammation of the liver and necrosis of liver cells, and carries about a 40% mortality risk for each hospitalization. Alcoholic cirrhosis represents irreversible scarring of the liver with loss of liver cells, and may be associated with alcoholic hepatitis. The scarring process greatly alters the circulation of blood through the liver and is associated with increased blood pressure in the portal (visceral) circulation and shunting of blood flow away from the liver and through other organs such as the esophagus. The potentially lethal complications of portal hypertension include rupture of esophageal varices, ascites or accumulation of fluid in the abdominal cavity, and the syndrome of hepatic encephalopathy, which is due to inadequate hepatic detoxification of substances in the visceral blood that is shunted around the liver. The risk of developing alcoholic cirrhosis is dependent upon the amount of alcohol exposure independent of the presence or absence of malnutrition. For example, a study of well-nourished German male executives found that the incidence of alcoholic cirrhosis was directly related to the daily amount and duration of alcohol consumption, such that daily ingestion of 160 g alcohol, equivalent to that found in a pint of whisky, over a 15-year period predicted a 50% risk of cirrhosis on liver biopsy. Other worldwide demographic data indicate that mortality rates from cirrhosis of the liver can be related to national per capita alcohol intake. These studies have defined the threshold risk for eventual development of alcoholic cirrhosis as 6 drinks per day for men, and about half that for women.

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