Alcoholic Liver Disease
(Am J Gastro 1998;93:2022-36)
DEFINITION:
Clinical spectrum includes fatty liver (occurs in days & is reversible), alcoholic hepatitis and alcoholic cirrhosis; Only 20% of alcoholics develop the later two
Dependency: impairment or distress, as manifested by three or more of the following within 12 months:
Tolerance, Withdrawal, Desire to cut down, Giving up important social activities, Continued use despite knowing of adverse effects
Abuse: impairment or distress, as manifested by one or more of the following within 12 months:
Not fulfilling obligation at work/school, Recurrent substance-related legal problems, Continuing situations when physically hazardous
Acute Alcohol Toxicity: large quantities of alcohol consumed over a short period can result in acute liver toxicity (acute alcohol poisoning)
Alcoholic Hepatitis: usually associated with heavy alcohol consumption for more than 10 years
EPIDEMIOLOGY:
Prevalence of alcohol abuse in general population: 9.4%; Alcohol is implicated in >50% of liver-related deaths in the U.S.
Incidence of progressive liver injury or cirrhosis is significantly increased in those who consume >40-60 gm alcohol/day
Approximately 20% of men drinking >8-12 beers/day develop cirrhosis in 10 years
ETIOLOGIES:
Beer (12 oz), Wine (5 oz), Hard liquor (1.5 oz/80 proof) = 10-14 grams of ethanol
The percentage of alcohol in each of the above is Beer: 6%, Wine: 10-20%, Hard liquor: 45% “Proof” refers to the percentage multiplied by 2
Moderate alcohol consumption: <20 gm/day ♀ and <40 gm/day ♂; Heavy alcohol consumption: >20 gm/day ♀ and >80 gm/day ♂
60-80 gm/day of ethanol (or 6-8 drinks/day) for 10 years will likely develop cirrhosis in ♂; half as much required in ♀
An average alcoholic beverage raises blood alcohol concentration by 15-20 mg/dl, the amount metabolized by the liver in 1 hour
Blood Level (mg/dl) | Expected Symptoms |
|---|---|
20-99 | Impaired coordination, euphoria |
100-199 | Ataxia, decreased mentation, poor judgment, anxiety |
200-299 | Marked ataxia, slurred speech, anxiety, nausea and vomiting |
300-399 | Sedation, memory lapse, labile mood |
>400 | Respiratory failure, coma, death |
PATHOPHYSIOLOGY:
Ultimately, the total amount of alcohol consumed per weight determines who is at risk for alcohol-related disease
Alcohol is metabolized mainly via the liver: alcohol dehydrogenase metabolizes to acetaldehyde, which in turn is oxidized by the liver via hepatic aldehyde dehydrogenase and the microsomal ethanol-oxidizing system cytochrome P450 (CYP2E1) to acetate
Aldehyde dehydrogenase (ALDH) is responsible for variable rates of alcohol clearance based on genetic inheritance
-Certain Asian populations carry impaired ALDH activity = accumulating acetaldehyde = symptoms of flushing, tachycardia, N/V: N/V, Flushing
-Disulfiram (Antabuse) takes advantage of this mechanism, inhibiting ALDH, and deters alcohol use because of symptoms: N/V, FlushingRelated posts:
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