Pathophysiology of Alcoholic. Consultant Gastroenterologist Wishaw General Hospital

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1 Pathophysiology of Alcoholic Liver disease. Beth Reed Consultant Gastroenterologist Wishaw General Hospital

2 MG 35 yr old class room assistant No sig PMHx has never been to hospitial No regular medication Drinks socially and one or two during the week Found to have abnormal LFTs at routine bloods

3 On close questioning Drinking 2 glasses of wine per night and another bottle on a Friday and Saturday night Binge drank from 16yrs old

4 Why Worry? Increasing prevalence in periods of economic unrest and hardship WHO globally ll alcohol lintake is stable or increasing Fi f ldi i i h i i th 35 Five fold increase in cirrhosis in those 35 55yrs

5 Why Worry? Population intake is proportional to the affordability Population mortality proportional to the population intake population intake Average die 20 25yrs earlier than CV respiratory Average die 20 25yrs earlier than CV, respiratory or stroke disease

6 Alcohol. Induces alteration in brain chemistry influences 3 main chemical systems in the brain linked to reward, relief and obsessive or craving and loss of control

7 Alcohol Addiction/Dependency characterised by physical dependency with a chronic relapsing remitting course with relapses triggared by craving Liability multi factorial Links include genetic & environmental factors

8 Alcoholic liver disease Anyone Complex and multi factorial Is a spectrum of underlying pathology

9 Produces a spectrum of disease from fatty liver disease through to cirrhosis Each stage can co exist Alcohol l causes damage through h3 main mechanisms Toxic effect on tissues and organs Acute intoxification Dependency

10 Risk Factors Clear dose dependant d relationship Drinking patterns steady heavy drinking probably worse than binge drinking Women are more at risk than men Ethnic Obesity Genetic Viral Infection Hepatitis C Virus

11 biochemistry The liver metabolises 90% of alcohol The reactive pathways result in Oxidative Damage Increased Fatty Acid accumulation within cells Altered immune function Altered regeneration capacity Leads to fat laid down within the liver, inflammation and scarring which progress to fibrosis and eventually cirrhosis

12 What is the effect on the liver? There are 4 main stages in the development of alcoholic liver disease. Steatosis Steatohepatitis i Fibrosis Cirrhosis (hepatocellular cancer)

13 Pathophysiology of ALD

14 Risk Factors Clear dose dependant d relationship Drinking patterns steady heavy drinking probably worse than binge drinking Women are more at risk than men Ethnic Obesity Genetic Viral Infection Hepatitis ii C Virus Upto 20% will have another cause of liver disease

15 Hepatocellular Carcinoma 1 8% of cirrhotics will develop HCC/yr Once have a diagnosis of cirrhosis should undergo 6 monthly screening Can be contained or even cured

16 Complications of ALD Ascites and peripheral oedema Altered renal blood flow sodium retention water retention Ascites and leg swelling

17 Complications of ALD Portal Hypertension

18 MG. At clinic had a full liver screen planned for an USS Referred to the Addictions service

19 Alcohol and the rest of the body Brain GI Cancers Cardiovascular Infection Diabetes

20 Alcohol and Brain Injury Withdrawal seizures and epilepsy Encephalopathy ARBD /atrophy

21 Alcohol and the GI Tract Liver disease Pancreatitis (acute/chronic) Malabsorption Diabetes

22 Alcohol and Cancers Head and Neck Female Breast Oesophagus Liver Colorectal

23 Alcohol and the Cardiovascular system HTN Cardiomyopathy Dysthrythmias y Haemorrhagic Stroke

24 Alcohol and the Immune system Perpetuates liver Disease & inflammation TB STI Pneumonia

25 MG Was lucky. USS was suggestive of fatty liver LFTs normalised after a period of abstinence Changed her relationship with alcohol

26 Questions?

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