Alcoholic liver disease

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Alcoholic liver disease is a spectrum of nonneoplastic liver diseases, clinical syndromes and pathological changes in the liver caused by alcohol [1]. In Canada in 1997, alcohol was the commonest etiology in deaths due to chronic liver disease and cirrhosis, accounting for about 50% of cases, especially in males (M:F=3:1). Alcoholic liver disease can be classified into fatty liver, alcoholic hepatitis, and alcoholic cirrhosis.

In fatty liver (steatosis), fatty change is reversible, disappearing in 4 weeks with abstinence from alcohol. It is usually asymptomatic, but may rarely cause sudden death in severe cases.

Alcoholic hepatitis shows a wide range of severity, from asymptomatic to fulminant hepatic failure. Usually, it is associated with heavy drinking. A liver biopsy is required for definite diagnosis. Microscopically, the liver shows swollen hepatocytes containing Mallory bodies (tangles of cytokeratin filaments), mixed lobular inflammation, and perivenular fibrosis.

Alcoholic cirrhosis is developed by only 10-15% of alcoholics. It may develop within as little as 1-2 years in patients with alcoholic hepatitis. Abstinence from alcohol improves liver function and survival. Classically, alcoholic cirrhosis is micronodular, macronodules may develop with time.