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 Laennec‘s cirrhosis, and micronodular cirrhosis.
• Chronic hepatitis C infection worsens alcoholic hepa­titis leading to alcoholic cirrhosis.

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.