Diagnosis and treatment of alcoholic liver disease and its complications

Abstract

Alcoholic liver disease (ALD) is a serious and potentially fatal consequence of alcohol use. The diagnosis of ALD is based on drinking history, physical signs and symptoms, and laboratory tests. Treatment strategies for ALD include lifestyle changes to reduce alcohol consumption, cigarette smoking, and obesity; nutrition therapy; and pharmacological therapy. The diagnosis and management of the complications of ALD are important for alleviating the symptoms of the disease, improving quality of life, and decreasing mortality.

Figure 1

Biopsies of alcoholic liver disease showing how a patient can progress from fatty liver and alcoholic hepatitis to cirrhosis.

Figure 2

Inadequate nutrition was directly related to mortality in the Veterans Health Administration studies in patients who had moderate to severe alcoholic hepatitis. It is not known whether providing nutrients directly into the gastrointestinal tract (that is, enteral feeding) to those patients with inadequate caloric intake would have improved their survival. NOTE: Kcal/day = Kilocalories per day.

Figure 3

(A) Patient with alcoholic cirrhosis who shows ascites, an umbilical hernia, and wasting of muscle. (B) After 2 years of abstinence and appropriate nutrition, the patient gained back muscle mass and his ascites improved.

Figure 4

View of varices in the esophagus, a consequence of liver disease, using endoscopy. These dilated veins are being banded to prevent gastrointestinal bleeding.