Alcoholic Cirrhosis Clinical features Physical findings Treatment

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

· 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.

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

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.