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Chapter: Medicine Study Notes : Gastro-Intestinal

Alcoholic Liver Disease

Macroscopic appearance: large, pale, liver with soft greasy cut surface

Alcoholic Liver Disease


·        Alcoholic Steatosis (Fatty Liver):


o  Pathogenesis: ­synthesis 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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Medicine Study Notes : Gastro-Intestinal : Alcoholic Liver Disease |

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