Volume 1 Issue 6 December, 2011
Consultation Liaison Psychiatry Focus: PATHOLOGY
Problems due to alcohol have been a worldwide phenomenon for generations. The consumption of alcohol is on the rise with the economic developments, more so in countries like India. Intake of alcohol beyond certain limits has serious health hazard, the liver being the most common organ involved. It has been suggested that ‘sensible drinking’ would be 28 units by men and 21 by women in a week. One unit is considered to be 8g of alcohol. Often units are quoted as being one small glass of wine or half a pint of beer or one pub measure of spirits. It is also recommended that at least one day a week should remain alcohol free and in a given day the amount should not exceed 4 units for men and 3 for women. However alcohol is not recommended for any health benefits.
Alcoholic liver disease is associated with consumption of alcohol. But, whether duration or quantity directly correlates with liver pathology is not certain. Subsets of individuals develop liver disease suggesting the role of genetic factors contributing the disease. Research has shown that individuals who have genes favouring a strong immune response are those at most risk of alcoholic liver disease. On the contrary the gene variant named CYP2E1 may protect against alcohol! Pathologic changes seen in alcohol induced liver diseases can be divided into 3 stages; alcoholic steatosis, steatohepatitis and alcoholic cirrhosis. Alcoholic steatosis is early and reversible, where lipid droplets accumulate within the hepatocytes. With abstinence these changes can return to normal in 3‐ 4 weeks. At this stage there will be elevated aspartate amino transferases (AST) and alanine aminotransferases (ALT).
Alcoholic hepatitis is an inflammatory liver disorder due to progressive intake of alcohol where there is neutrophilic infiltration in the liver accompanied by ballooning degeneration and Mallory hyaline inclusions in the hepatocytes. With abstinence these changes can resolve in months. At this stage there is elevation of aspartate aminotransferase. Studies have shown that C reactive marker protein is an accurate marker of alcoholic hepatitis. Liver biopsy may be needed if the diagnosis is in doubt or other concomitant pathology is suspected such as hepatitis C infection.
Alcoholic hepatitis progresses to cirrhosis which is irreversible. The cirrhosis is often micronodular type, where there is destruction of normal architecture of liver by fibrous septa which encompass the regenerative nodules of hepatocytes. If the patient stops alcohol intake at this stage, the parenchymal regeneration improves, nodules increase in size and become macronodular and all features of alcoholic aetiology disappear. It is found that a high AST/ALT ratio is suggestive of advanced alcoholic liver disease. Liver biopsy is indicated to characterize the extent of damage, providing prognosis and helping in therapeutic decision making.
To conclude there is no single physical examination finding or a laboratory test that can be specific for alcoholic liver disease. Liver pathology reports serves as important feedback to patient & his family in educating & motivating him to control Alcohol.
