ALCOHOLIC LIVER CIRRHOSIS

Alcoholic liver disease is a term that encompasses the hepatic manifestations of alcohol over consumption, including fatty liver, alcoholic hepatitis, and chronic hepatitis with hepatic fibrosis or cirrhosis. It is the major cause of liver disease in Western countries. Although steatosis (fatty liver) will develop in any individual who consumes a large quantity of alcoholic beverages over a long period of time, this process is transient and reversible Of all chronic heavy drinkers, only 15–20% develop hepatitis or cirrhosis, which can occur concomitantly or in succession.

How alcohol damages the liver is not completely understood. 80% of alcohol passes through the liver to be detoxified. Chronic consumption of alcohol results in the secretion of pro-inflammatory cytokines (TNF-alpha, IL6 and IL8), oxidative stress, lipid peroxidation, and acetaldehyde toxicity. These factors cause inflammation, apoptosis and eventually fibrosis of liver cells. Why this occurs in only a few individuals is still unclear.

ADDITIONALLY, THE LIVER HAS TREMENDOUS CAPACITY TO REGENERATE AND EVEN WHEN 75% OF HEPATOCYTES ARE DEAD, IT CONTINUES TO FUNCTION AS NORMAL.

RISK FACTORS:

• Quantity of alcohol taken: consumption of 60–80g per day (about 75–100 ml/day) for 20 years or more in men, or 20g/day (about 25 ml/day) for women significantly increases the risk of hepatitis and fibrosis by 7 to 47%
  
  
  
  • Pattern of drinking: drinking outside of meal times increases up to 2.7 times the risk of alcoholic liver disease.
  
  
  • Gender: females are twice as susceptible to alcohol-related liver disease, and may develop alcoholic liver disease with shorter durations and doses of chronic consumption.
  
  
  • Hepatitis C infection: a concomitant hepatitis C infection significantly accelerates the process of liver injury.
  
  
  • Genetic factors: genetic factors predispose both to alcoholism and to alcoholic liver disease.
  
  
  • Iron overload (hemochromatosis)
  
  
  • Diet: malnutrition, particularly vitamin A and E deficiencies, can worsen alcohol-induced liver damage by preventing regeneration of hepatocytes. This is particularly a concern as alcoholics are usually malnourished because of a poor diet, anorexia, and encephalopathy.