Alcohol-related Liver Disease

Alcohol-related liver disease (ARLD) refers to liver damage caused by excess alcohol intake. There are several stages of severity and a range of associated symptoms:

1. Alcoholic fatty liver disease - reversible after 2 weeks of drink free
2. Alcoholic Hepatitis - first point of symptoms. Usually reversible. Severe alcoholic Hepatitis can be life threatening
3. Liver Cirrhosis

Causes/Factors

• Binge drinking → fatty liver disease and sometimes alcoholic Hepatitis
• Chronic alcohol abuse → alcoholic Hepatitis and Liver Cirrhosis
• Overweight/obese
• Females seem to be more vulnerable to the harmful effects than men
• Genetics

Symptoms

• Nausea
• Weight loss
• Loss of appetite
• Jaundice
• Oedema
• Ascites

Diagnostic Tests

• Liver function tests ($\downarrow$ albumin) - AST/ALT > 2 is characteristic of alcoholic Hepatitis
  • $\gamma$GT especially raised
• Ultrasound
• Biopsy
• Raised MCB

Management

• Stop drinking
• Good diet and nutrition
• Corticosteroids (Prednisolone) reduces mortality
• Liver transplant if Liver failure occurs

Complications/red Flags

• Hepatic encephalopathy - reduce ammonia by giving lactulose (excreted in stool)

Alcohol Withdrawal

Dependance on alcohol and then suddenly going cold turkey has a risk of progressing to withdrawal and Delirium tremens.

• 6-12h: tremors, sweating, headache, craving, anxiety
• 12-24h: hallucinations
• 24-48h: seizures
• 24-72h: Delirium tremens

Management

• Chlordiazepoxide - benzo used to combat the effects. Given orally and titrated
• High dose B vitamins (Pabrinex) IV, followed by long term oral thiamine. Prevention of Wernicke-Korsakoff syndrome

Delirium tremens

• Medial emergency - 35% mortality if left untreated
• Removal of the depressant causes the brain to become extremely excitable.