Alcoholic Liver Disease
·
Alcoholic Steatosis (Fatty Liver):
o Pathogenesis: Âsynthesis of TAGs + ¯fatty acid oxidation + ¯formation/release of lipoproteins ® fat in lymphocytes
o Macroscopic appearance: large, pale, liver with soft greasy cut surface
o Microscopic appearance: Micro and macro-vesicular types.
Intracytoplasmic droplets coalescing to fill the cell, may rupture (no
inflammation before rupture). Perivenular fibrosis
o Outcome: Liver function may be normal. If no fibrosis then can be cleared
o Fatty liver can also be caused by toxic, metabolic and hypoxic
conditions, and occurs in malnourished kids in the third world
·
Alcoholic hepatitis:
o Acutely following heavy drinking
o Often superimposed on fatty change or cirrhosis
o Microscopic appearance:
§ Similar to viral hepatitis
§ Liver cell necrosis and inflammatory infiltrate
§ Mallory bodies (alcoholic hyaline): intracytoplasmic collection of cyto-skeletal proteins. Looks like candy floss
§ Fibrosis
·
Alcoholic Cirrhosis:
o Causes 60 – 70% of cirrhosis.
Most of the rest is viral
o Only 10% of alcoholics get cirrhosis
o Requires daily alcohol of > 60 gm (1/3 bottle of spirits)
o Macroscopic appearance:
§ Initially large, fatty, micronodular (liver cells regenerating between
fibrosis)
§ Progresses to small, non-fatty, macronodular (>10 mm) liver. Often
micro-macro nodular presentation
o Microscopic appearance:
§ Early: delicate portal-central fibrosis, fatty parenchyma.
§ Late: enlarged nodules surrounded by broad fibrous bands (with signs of
liver failure). Bile retention within nodules
o Immediate causes of death: hepatic coma, GI bleed, infection,
hepatocellular carcinoma, head injury ® subdural haematoma
· Alcohol also ® pancreatitis
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