Alcoholic Liver Disease (ALD) - Pathophysiology, Biomarkers & Imaging

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Alcoholic Liver Disease (ALD) - Pathophysiology, Biomarkers & Imaging




Spectrum of excessive Alcohol consumption leads to : 

1. Alcoholic Steatosis / Steatohepatitis with or without fibrosis (ASH)

2. Alcoholic Hepatitis  (AH)

3. Cirrhosis


Alcoholic Steatohepatitis:

20 to 40 % patients who drink alcohol in heavy amounts and have fatty liver (steatosis) , eventually develop inflammation (steatohepatitis)


Alcoholic Hepatitis:

A severe syndrome of alcoholic liver disease, characterized by rapid onset of jaundice, malaise, tender hepatomegaly & features of systemic inflammatory response

Acute binge is likely the trigger for AH in patients with history of chronic alcohol abuse

Criteria - 

1. Heavy Alcohol Consumption: > 50 g/day for minimum 6 months

2. Elevated AST (never greater than 500 U/L)

3. AST/ALT ration > 1.5


Alcohol induced chronic liver disease

Not dose dependent

Correlation of alcohol consumption and and liver injury is not linear


Biomarkers of heavy drinkers:

Raised levels of AST / ALT / GGT / Ferritin and albumin


Imaging:

1. Fatty accumulation

2. Signs of chronic liver disease

3. Inflammation / Fibrosis on Elastography


References:

1. https://www.ncbi.nlm.nih.gov/books/NBK470217/

2. https://academic.oup.com/alcalc/article/44/2/199/184610

3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3438811/


Prepared by: Dr. Sharad Maheshwari

Published: 2.10.2023

Updated: 18.2.2023

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