Abstract
The association of alcohol with cirrhosis has been recognised for centuries. Worldwide, the consumption of alcohol is increasing. It is, however, becoming less in France (Government propaganda) and in the United States (changing life styles). Only 10-15% of those who abuse alcohol will develop cirrhosis. Risk factors are uncertain, but include dose and duration of alcohol consumption and female sex.
Genetic differences in the metabolism of alcohol are important. Nutrition is of less importance.
Alcohol is predominantly metabolised in the liver, the maximum is 160 to 180 g/day. 1 gm alcohol gives 7 calories and the alcoholic literally runs on spirit.
The mechanisms by which the liver is damaged are uncertain. One factor may be acetaldehyde which is generated when alcohol is metabolised and is highly toxic. The changes in the liver go from fatty change, to acute alcoholic hepatitis, to cirrhosis and occasionally to liver cancer.
Early recognition of alcoholic liver damage depends on the physician's suspicions, digestive symptoms, enlarged liver and an increase in the blood of liver enzymes (transaminases and especially, gammaglutamyl transpeptidase (Gamma GT). The red blood cells are increased in size (macrocytosis).
Acute alcoholic hepatitis follows heavy consumption without eating. The patient is jaundiced and toxic and there is a high mortality.
Cirrhosis is the end-stage of alcoholic liver damage. It is marked by jaundice, fluid in the belly (ascites), mental changes and bleeding from veins in the food pipe (oesophageal varices). Cirrhosis is irreversible.
The outlook for cirrhosis in alcoholics is better than for other forms of cirrhosis, particularly if the patient abstains. The treatment otherwise is along the lines of any other form of chronic liver disease.
Alcoholic cirrhosis is a self-inflicted disease. Donor organs are in short supply and there may be reluctance to consider liver transplantation. It is reserved for those with end-stage disease, who have been abstinent for at least 6 months, have a good job to return to, good family support and no other alcohol-related disease. The results are the same as for other types of cirrhosis.
About 10% return to alcoholism after the transplant. ■
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