Alcoholic Liver Disease

ALCOHOLIC LIVER DISEASE

Fatty change (steatosis) is reversible with abstinence. The gross appearance is of an enlarged, yellow, greasy liver. Microscopically, the liver initially shows centrilobular macrovesicular steatosis (reversible) that can eventually progress to fibrosis around the central vein (irreversible).

Alcoholic hepatitis is an acute illness that usually follows a heavy drinking binge. Some patients have no symptoms and others develop RUQ pain, hepatomegaly, jaun-dice, malaise, anorexia, or even fulminant liver failure.

Microscopically, the liver shows hepatocyte swelling (ballooning) and necrosis, Mallory bodies (cytokeratin intermediate filaments), neutrophils, fatty change, and eventual fibrosis around the central vein. The prognosis can be poor, since each episode has a 20% risk of death, and repeated episodes increase the risk of develop-ing cirrhosis.

Alcoholic cirrhosis develops in 15% of alcoholics, and is typically a micronodular or Laennec cirrhosis.