Alcoholic Cirrhosis Clinical features Physical findings Treatment

Alcoholic Cirrhosis Clinical features Physical findings Treatment

ALCOHOLIC CIRRHOSIS

  • This results from chronic alcohol ingestion and may follow alcoholic fatty liver and alcoholic hepatitis.
  • It is also called Laennecs cirrhosis, and micronodular cirrhosis.
  • Chronic hepatitis C infection worsens alcoholic hepa­titis leading to alcoholic cirrhosis.

Alcoholic Liver Disease

Alcoholic Cirrhosis Clinical features Physical findings Treatment


Alcoholic Cirrhosis Clinical features

  • · It may be symptomless
  • · There is slow onset of symptoms after about 10 years of alcohol intake, progressive in weeks and months.
  • · There is progressive liver dysfunction and portal hypertension i.e. jaundice, bleeding from gastrooesophageal varices, ascites and encepha­lopathy.
  • • The liver is firm, nodular, may be enlarged or shrunken (decreased in size).
  • · There is jaundice, palmar erythema (red palm), spider angiomas or spider nevi (spider-like dila­tation of capillaries seen on the skin), splenom­egaly, clubbing, muscle wasting (loss of skeletal muscle mass), ascites, and peripheral oedema.
  • · There is anorexia, weight loss.
  • · There is weakness, fatigue, easy bruising.
  • · Men may have gynaecomastia, testicular atro­phy.
  • · Women may have menstrual irregularity.
  • · There is Dupuytren’s contracture due to palmar fascia fibrosis (claw hand).
  • · Patient may go into hepatic coma and die.
  • · There may be renal dysfunction and failure also.

Physical findings in alcohol abuse

  • Abdominal wall collaterals (caput medusa)
  • Ascites
  • Cutaneous telangiectasias
  • Digital clubbing
  • Disheveled appearance
  • Dupuytren’s contractures
  • Gynecomastia
  • Jaundice
  • Malnutrition
  • Palmar erythema
  • Peripheral neuropathy
  • Splenomegaly
  • Testicular atrophy

Abnormality Diagnostic characteristics

  • Serum AST>ALT (ratio usually >2.0, both usually <300 IU/L, and almost never >500 IU/L) Sensitivity and specificity have not been well studied, but may vary with the magnitude of the ratio
  • Elevated serum AST Sensitivity 50 percent
  • Specificity 82 percent
  • Elevated serum ALT Sensitivity 35 percent
  • Specificity 86 percent
  • Elevated serum GGT Sensitivity approximately 70 percent
  • Specificity approximately 60 to 80 percent

Lab findings

  • · Anaemia, hemolytic anaemia
  • · Hypercholesterolemia
  • · Hyperbilirubinaemia
  • · Elevated serum alkaline phosphatase
  • · Elevated AST (Aspartate aminotransferase)
  • · AST / ALT ratio is more than 2
  • · Serum prothrombin time is prolonged
  • · Serum albumin is decreased
  • · Insulin resistance occurs leading to glucose in- tolerance
  • · Respiratory alkalosis, hypokalemia
  • · Hypomagnesemia, hypophosphatemia
  • · Pre-renal azotemia.
  • Ultrasound
  • • Hepatomegaly or shrunken liver.

ACG guideline for the diagnosis of alcoholic liver disease

  • All patients should be screened for alcoholic liver disease. A thorough history of alcohol use should be obtained. The CAGE questionnaire is a useful screening method for alcohol abuse or dependency.
  • A detailed physical examination should be done, searching for signs of chronic liver disease and staging its severity.
  • A liver chemistry profile (including serum albumin, bilirubin and transaminases [AST/ALT]). A complete blood count and prothrombin time or INR should be obtained to support a clinical suspicion of alcoholic liver disease and to assess its severity.
  • However, both laboratory abnormalities and physical findings may be minimal or absent even in patients with established alcoholic liver disease. When evaluating a patient for alcoholic liver disease, the clinician must remember that the toxic daily threshold dose of 80 g of alcohol is not absolute. Elevations in serum ALT may develop at much lower doses, especially in women and patients with hepatitis C infection.
  • It may be necessary to perform a liver biopsy in patients with suspected alcoholic liver disease when the diagnosis is unclear because of atypical features or possible concomitant disease.

Alcoholic Cirrhosis Treatment

  • Supportive treatment
  • Specific treatment for bleeding Glucocortioids may be helpful
  • S-adenosyl methionine may increase survival by decreasing inflammatory cytokines
  • Counselling
  • Diuretics, Aspirin, Paracetamol should be avoided.
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