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Alcoholic Liver Disease

a. Hepatic Steatosis  
b. Alcoholic hepatitis
c. Cirrhosis

Steatosis Micro vesicular Macro vesicularQ

  1. Initially Centrilobular
  2. Liver: Enlarged, yellow, greasy. Easily fractured
  3. Reversible - till fibrosis appears 

B. Hepatitis

  1. Hepatocyte swelling and necrosis
  2. Mallory bodiesQ: Tangled skeins of cytokeratin intermediate filaments and other protein. Also seen in ­
    1. Alcoholic Liver disease                        
    2. Primary Biliary cirrhosis
    3. Wilson's disease                      
    4. Chronic cholestatic syndrome
    5. Hepatocellular tumors
  3.  Neutrophilic reaction
  4.  Centrilobular fibrosis and peri venular fibrosis:

C. Cirrhosis

  1. Final and irreversible form
  2. Liver: Initially: yellow, fatly, enlarged
  3. Later: Brown, Shrunken non-fatty uniform micro nodules larger (Hobnail appearance)
  4. Mixed micro and macro nodular
  5. Ischemic necrosis and fibrous obliteration of nodules   broad expanses of tough, pale, scar tissue (Laennec cirrhosis) 

D. Pathogenesis:

  1. Short term, 80 gm of alcohol Mild, reversible fatty change
  2. 80 gm, daily risk of severe hepato injury
  3. ~ 160 gm, 10-20 years severe injury
      10-20% Alcoholics have cirrhosis
      Women More susceptible 

E. Cause of alcohol induced liver damage

  1. Hepatocellular steatosis - Cause,.
    1. Shunting of normal substrates from catabolism to lipid synthesis due to increase NADH by alcohol dehydrogenase and acetaldehyde dehydrogenase
    2. Increased peripheral catabolism of lipid, impaired assembly and secretion of lipoprotein
  2. Induction of cytochrome P 450
  3. Free radical generation
  4. Direct effect on micro tubular and mitochondrial function and membrane fluidity
  5. Immunologic attack of hepatic neoantigens Q
  6. Intrahepatic glutathione levels (GSH) thereby sensitizing the liver to oxidative injury 

F. Causes of Death

  1. Hepatic coma                     
  2. Massive GIT bleeding
  3. Intercurrent infection           
  4. Hepatorenal infection
  5. HCC: 3%-6%

G. Non Alcoholic steato hepatitis Q

  1. Obesity - most important Risk factor
  2. Type II DM c. Hypertriglyceridemias

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