Liver & GIT
Which of the following enzyme assay is useful to diagnose alcoholism .(AIIMS Nov 11)
Types of cirrhosis
1. Alcoholic Cirrhosis (Ref. H-18thedi, Pg 2589)–
It is also known as Laënnec’s cirrhosis. It is characterized by diffuse fine scarring, uniform loss of liver cells and small regenerative nodules.
Clinical Syndromes Of Alcoholic Liver Disease
A. Fatty liver
i. Asymptomatic abnormal liver biochemistry ii. Large liver (Increase liver span)
B. Alcoholic hepatitis
i. Jaundice ii. Malnutrition
iii. Hepatomegaly iv. Feature of portal hypertension (e.g. ascites, encephalopathy)
i. Large, normal or small liver
iii. Hepatocellular carcinoma
iv. Stigmata of chronic liver disease. More commonly seen in alcoholic cirrhosis
1. Signs of liver cell failure, Q
2. Parotid and lacrimal, Gland enlargement, Q
3. Clubbing, Q
4. Gynecomastia, Q
5. Testicular atrophy Q
6. Dupuytren’s contracture are seen. Q
Causes of Mallory’s hyaline
1. Primary Biliary Cirrhosis 2. Indian Childhood Cirrhosis 3. Alcoholic liver disease
Pathological Features Of Alcoholic Liver Disease
A. Alcoholic hepatitis B. Macrovesicular cirrhosis
i. Lipogranuloma i. Fibrosis and cirrhosis
ii. Neutrophil infiltration ii. Central hyaline sclerosis
iii. Mallory’s hyaline iii. Pericellular fibrosis
1. Anemia – due to GIT
a. Blood loss,
b. Nutritional deficiency (Folate, vit. B12)Q
c. Hypersplenism Q,
d. A direct suppressive effect of alcohol on bone marrow.
e. Hemolytic anemia due to effect of hypercholesterolemia on RBC membrane (Acanthocytosis) Q.
f. A unique form of hemolytic anemia (with spur cell &acanthocyte) called Zieve’s syndrome can occur is patient of severe alcoholic hepatitis.
3. AST/ALT ratio > 2 is highly suggestive of alcoholic liver disease. ALP is increase but level are< 3 times of normal
4. Serum Albuminis decreased while serum globulin are increased.
5. Increased ammonia levels in hepatic encephalopathy are seen.
6. Hypokalemia due to hyper aldosteronism
7. AST, ALT raised but not more then 400IU/L
8. Increase gamma GT
(Note: In toxic liver disease & viral hepatitis AST , ALT level are > 400 IU/L
Causes of AST >ALT
a. Alcoholic hepatitis
b. Fatty liver in Pregnancy
Extra Edge: In Alcoholic liver diseases
1. Increase TG 2. Increase Cholesterol, 3. Increase TLC, 4. Macrocytosis
In alcoholic liver disease there is iron over load state i.e. increase serum ferritin and increase serum iron.