Metabolic Liver Disease

Alcoholic Liver Disease

Pathology:                Alcohol excess can cause inflammation resulting in fat being deposited in the liver

Steatosis ➜  steatohepatitis ➜ fibrosis ➜  cirrhosis

Aetiology:                 Excess Alcohol Consumption

Symptoms:               Ascites

Signs:                          Spider naevi, ascites, peripheral oedema, jaundice, asterixis, caput medusae, splenomegaly, Dupuytren’s contracture

Investigations:      Bloods: FBC shows a macrocytic anaemia and LFTs show AST:ALT ratio >2

Imaging: Ultrasound Abdomen may show fatty liver and hepatomegaly

Liver Biopsy: Steatosis and Steatohepatitis

Treatment:              Conservative: Cessation of alcohol

Medical: Glasgow Alcoholic Hepatitis Score ≥9 may benefit from steroids.

     Maddrey’s Discriminant Function Score assess bilirubin and PT with a

  score ≥32 indicating a possible benefit from steroids.

Complications:      Liver Cirrhosis

Prognosis:                Maddrey Score ≥32 has a poor prognosis

Non-Alcoholic Fatty Liver Disease

Pathology:                Similar pathologically to alcoholic liver disease

Aetiology:                 Associated with diabetes, obesity, metabolic syndrome

Symptoms:               Asymptomatic

Signs:                          Asymptomatic

Investigations:      Bloods: FBC, Lipids, Glucose and LFTs show AST:ALT ratio <1

Imaging: USS Abdomen may show a bright liver

Liver Biopsy: Steatosis and Steatohepatitis. Mallory bodies common in non-

 alcoholic steatohepatitis

Treatment:              Conservative: Lifestyle advice

Medical: Control hypertension and improve diabetic control

Complications:      Can progress to fibrosis then cirrhosis

Prognosis:                8–30% of developing fibrosis or cirrhosis after 10 years

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