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ALCOHOLIC LIVER
INTRODUCTION
LIVER
ALCOHOLIC LIVER
DISEASE
CASE STUDY
LIVER
Liver is one of the largest organ
in our body.,weighs upto 1500
grams in adults.
ALCOHOLIC LIVER
CIRRHOSIS
Alcoholic liver disease is a term that encompasses the hepatic
manifestations of alcohol overconsumption, including fatty
liver, alcoholic hepatitis, and chronic hepatitis with hepatic
fibrosis or cirrhosis.
It is the major cause of liver disease in Western countries.
Term was 1st coined by Laennec in 1826
Primary histologic features:
1. Marked fibrosis
2. Destruction of vascular & biliary elements
3. Regeneration
4. Nodule formation
About Alcohol :
Alcohol beverage is a drink that contains ethanol
In the bloodstream, from the stomach, alcohol is absorbed between
5-10 minutes
Fact : females absorb alcohol faster than males because their bodies
contain less water
Problem With Alcohol Beverages:
Alcohol beverages are being consumed everyday, but consuming too
much can bring problems
An example would be alcoholic liver disease(cirrhosis),heart
disease, cancer and strokes
Cause addiction
Stages Of ALD :
There are three main stages of alcoholic liver disease, although there is
often an overlap between each stage. The three stages are explained
below.
Alcoholic fatty liver disease
Alcoholic fatty liver disease is the first stage of alcoholic liver disease.
Drinking a large amount of alcohol, even for only a few days, can lead to
a build-up of fatty acids in the liver.
Fatty liver disease rarely causes any symptoms but it is an important
warning sign that you are drinking at a level that is harmful to your health.
Fatty liver disease is reversible. If you stop drinking alcohol for two
weeks, your liver should return to normal.
Alcoholic hepatitis
Alcoholic hepatitis (not related to infectious hepatitis) is the second, more
serious stage of alcoholic liver disease.
Prolonged alcohol misuse over many years can cause the tissues of the liver to
become inflamed. This is known as alcoholic hepatitis. Less commonly, alcoholic
hepatitis can occur if you drink a large amount of alcohol in a short period of time
(binge drinking).
Alcoholic hepatitis is usually reversible, although you may need to stop drinking
alcohol for several months or years.
Cirrhosis
Cirrhosis is the final stage of alcoholic liver disease. Cirrhosis happens when
prolonged inflammation causes scarring of the liver and loss of function. Loss of
liver function can be life threatening.
The damage caused by cirrhosis is not reversible. In mild to moderate cases,
stopping drinking alcohol immediately should prevent further damage and lead to
the gradual recovery of liver function. In more severe cases, a liver transplant may
be required.
Epidemiology
of liver disease deaths. And figures show victims of liver disease are
getting younger more than 1 in 10 of deaths of people in their 40s
are from liver disease, most of them from alcoholic liver disease
Risk Factors :
Signs
Symptoms
Symptoms vary based on how bad the disease is. You may not have
symptoms in the early stages. Symptoms tend to be worse after a
period of heavy drinking.
Digestive symptoms include:
Pain and swelling in the abdomen
Decreased appetite and weight loss
Nausea and vomiting
Fatigue
Dry mouth and increased thirst
Diagnostic tests
Treatment
The first treatment of alcohol-induced liver disease is cessation of
alcohol consumption. This is the only way to reverse liver damage
or prevent liver injury from worsening. Without treatment, most
patients with alcohol-induced liver damage will develop liver
cirrhosis
Counseling may be necessary to break the alcohol addiction.
Vitamins, especially B-complex and folic acid, can help reverse
malnutrition.
Diet
Liver transplantation
Case Study
A 70 years old male patient was admitted in the hospital on 10/07/12
Chief Complaints :
C/o: abdominal distention since 4days
weakness since 15days
decreased appetite since 15days
weight loss since 15days
On Examination :
Patient is conscious and oriented
No cyanosis/icterus/clubbing
B.P-120/80 mm Hg
RR-20 b/m
PR- 80b/m
CVS-S1S2 +ve
Social History :
Alcoholic,
Smoker,
Belongs to low economic status,
Married ,
Non-Allergic
Lab Investigations
CBC
Hb 12g/Dl ()
RBC 3.2 M/micro L ()
WBC 6700 /mm3
ESR 20mm/hr ()
LFT
SGOT-169 microL ()
SGPT-162 microL ()
ALP 58 microL ()
Albumin 3.1 gm/dl ()
Globulin 21gm
RFT
BUN-12mg/dL
Sr.Cr-0.7mg/dL
Special investigations
Hbs Ag : -ve (impression)
US Abdomen : coarse texture
Gall Bladder : wall thickening
Spleen : enlarged mass
Diagnosis :
Alcoholic liver cirrhosis
Drug Chart
S.N Drug Name
o
ROA
Frequency
Duration
10 11 12
13
Inj.Monocef (1g)
IV
(cephalosporinantibiotic
)
BD
Y
-
T.Udiliv(600mg)
(ursodeoxycholic acid)
po
TDS
- Y Y -
Inj.pantoprazole(40mg)
(proton pump
inhibhitors)
IV
BD
Y
Y
Tab.Hepameez(10mg)
(L-ornithine+ Laspartate)
PO
OD
Inj.Metronidazole(160mg
)
(anti-eleminthic)
IV
OD
_ Y
Syp.duphalac (2tsp)
Bisacodyl - laxative
PO
SOS
Y
Y
Y
_
Y Y
SOAP NOTES
SUBJECTIVE :
A 7OYrs old male patient was admitted in the hospital
on 10/7/12, with c/o: abdominal distension since 4days, weakness
since 15days, decreased appetite since 15days, weight loss since
15days,past medical & medication history nil, Social history
-Alcoholic, Smoker, Belongs to low economic status, Married ,
Non-Allergic.
OBJECTIVE :
patient was to be found, abnormalities of LFT, CBC&
social history &US Abdomen : coarse texture, Gall Bladder :
wall thickening, Spleen : enlarged mass.
Assessment :
Based upon the above abnormalities,patient was
assessed to be suffering from alcoholic liver cirrhosis.
Plan :
Refer to Drug Chart
Drug Chart
S.N Drug Name
o
ROA
Frequency
Duration
10 11 12
13
Inj.Monocef (1g)
IV
(cephalosporinantibiotic
)
BD
Y
-
T.Udiliv(600mg)
(ursodeoxycholic acid)
po
TDS
- Y Y -
Inj.pantoprazole(40mg)
(proton pump
inhibhitors)
IV
BD
Y
Y
Tab.Hepameez(10mg)
(L-ornbthine+ Laspartate)
PO
OD
Inj.Metronidazole(160mg
)
(anti-eleminthic)
IV
OD
_ Y
Syp.duphalac (2tsp)
Bisacodyl - laxative
PO
SOS
Y
Y
Y
_
Y Y
Thank you